Provider Information for 1124594577
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SHAROLYN HENDERSON
Sex: Female
NPI: 1124594577
Last Updated: 2024-07-24
Certification Date: 2024-07-24
Certification Date: 2024-07-24
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1124594577 | ||||||||||||
| Enumeration Date | 2018-10-23 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 20055 SALLIE DR PLAQUEMINE, LA 70764-5321 United States Phone: 225-892-4564 | Fax: | ||||||||||||
| Primary Practice Address | 20055 SALLIE DR PLAQUEMINE, LA 70764-5321 United States Phone: 225-892-4564 | Fax: | ||||||||||||
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