Individual
LEA HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
731 LEE DR, LAS VEGAS, NM 87701-4932
(505) 426-4042
Mailing address
731 LEE DR, LAS VEGAS, NM 87701-4932
(505) 426-4042
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
CNP-02556
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
57773734
—
NM
Enumeration date
11/04/2014
Last updated
09/18/2018
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