Individual
MRS. LYNN ELLEN HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
PO BOX 13492, AUSTIN, TX 78711-3492
(415) 644-5051
Mailing address
7404 W DARROW ST, LAVEEN, AZ 85339-2643
(602) 303-5376
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
AP5555
AZ
363LA2200X
Adult Health Nurse Practitioner
71001704
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000562731
BLUE CROSS
IN
05
—
200514540
—
IN
Enumeration date
01/02/2007
Last updated
02/01/2019
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