Individual
JESSICA LYNN HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
4420 LAKE BOONE TRAIL, RALEIGH, NC 27607-2360
(919) 784-3100
Mailing address
3100 SPRING FOREST RD, SUITE 130, RALEIGH, NC 27616-2880
(919) 873-9533
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
2010-00808
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174745665
—
NC
Enumeration date
05/03/2007
Last updated
12/15/2020
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