Provider Information for 1275833592
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NICHOLE HENDERSON
Sex: Female
NPI: 1275833592
Last Updated: 2024-02-26
Certification Date: 2024-02-26
Certification Date: 2024-02-26
Details
| Name | Value | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1275833592 | ||||||||||||||||
| Enumeration Date | 2010-11-02 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 9402 W LAKE MEAD BLVD LAS VEGAS, NV 89134-8312 United States Phone: 702-530-3124 | Fax: | ||||||||||||||||
| Primary Practice Address | 9402 W LAKE MEAD BLVD LAS VEGAS, NV 89134-8312 United States Phone: 702-530-3124 | Fax: | ||||||||||||||||
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