Individual
MRS. LOREAL RACQUEL HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3436 MARY ELDER RD NE, OLYMPIA, WA 98506-5050
(360) 528-2590
Mailing address
3136 EAGLE LOOP NE, OLYMPIA, WA 98516-3145
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP60717401
WA
Other
Enumeration date
06/14/2022
Last updated
06/14/2022
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