Individual
CHARLES A HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
1312 SW WASHINGTON ST, PORTLAND, OR 97205-2327
(503) 535-1151
Mailing address
1905 SE 175TH CT, VANCOUVER, WA 98683
(503) 703-5414
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
200241980RN
OR
Other
Enumeration date
06/07/2021
Last updated
06/07/2021
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