Individual
MR. RANDALL WAYNE HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BC-HIS
Contact information
Practice address
10404 W COGGINS DR, SUITE 110, SUN CITY, AZ 85351-3437
(623) 974-9666
(623) 974-4813
Mailing address
2510 E SUNSET RD, UNIT 5-260, LAS VEGAS, NV 89120-3511
(702) 798-0113
(866) 291-5242
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
00729
IA
237700000X
Hearing Instrument Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0227132
—
IA
01
—
348031700
DOL NUMBER
—
05
—
42150911900
—
NE
Enumeration date
03/16/2007
Last updated
07/18/2014
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