Mary K Henricksen, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

4704081708 Issued in MI

Practice address

580 W College Ave
Marquette, MI 49855-2705

Phone

(906) 225-3406

Fax

(906) 225-3094

NPI assigned

Nov 18, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• DLP Marquette General Hospital LLC

  dba UP Health System Marquette

  • Certified Registered Nurse Anesthetist
  • Marquette, MI
  • NPI 1841541695

  Nurse Anesthetist, Certified Registered

  NPD (past)
• Marquette General Hospital, Inc.

  • Certified Registered Nurse Anesthetist
  • Marquette, MI
  • NPI 1639332455

  Nurse Anesthetist, Certified Registered

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208822400000",
    "number": "1821070392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "E3110 E DEER LAKE RD",
            "city": "AU TRAIN",
            "state": "MI",
            "postal_code": "498069512",
            "telephone_number": "906-892-8530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 W COLLEGE AVE",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498552705",
            "telephone_number": "906-225-3406",
            "fax_number": "906-225-3094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENRICKSEN",
        "first_name": "MARY",
        "middle_name": "K",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-18",
        "last_updated": "2008-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704081708",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104135850",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WI MEDICAID PIN",
            "identifier": "43288000",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "430051912",
            "identifier": "430051912",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUESHIELD PIN",
            "identifier": "MH081708",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lindsay Ann Heino
• Madelyn Jane Helgestad
• Sabrina Helmer, RD
• Jane Hendrick, LMT
• Melissa T Hendrickson, PA
• Jane Henry-Burton, LMSW
• Heidi Kristine Henry, MD
• Sheila Kay Henshaw, RN, MSN
• Heritage Health, P.C.
• Heritage Health, PC

• Certified Registered Nurse Anesthetist in Marquette, MI
• Providers in Marquette, MI by specialty
• Certified Registered Nurse Anesthetist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.