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Individual

DARLENE HENDERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
2080 S E ST, SAN BERNARDINO, CA 92408-2773
(909) 388-9191
Mailing address
2080 S E ST, SAN BERNARDINO, CA 92408-2773
(909) 388-9191

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
732701
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1760651178
CA
Enumeration date
05/11/2017
Last updated
05/11/2017
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