Provider Demographics
NPI:1174740781
Name:DUHADWAY, HENRY M (RN, MSN, ANP)
Entity type:Individual
Prefix:MR
First Name:HENRY
Middle Name:M
Last Name:DUHADWAY
Suffix:
Gender:M
Credentials:RN, MSN, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:1007 SUGAR CREEK CT
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-7425
Mailing Address - Country:US
Mailing Address - Phone:314-910-8460
Mailing Address - Fax:
Practice Address - Street 1:5000 MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-2012
Practice Address - Country:US
Practice Address - Phone:314-747-5800
Practice Address - Fax:314-747-5866
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO75908363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO427544606Medicaid
MO427544606Medicaid