Individual
ANNIE LAURA HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
10 TOWER DR, SUN PRAIRIE, WI 53590-1239
(608) 825-3500
(608) 825-3793
Mailing address
514 THOMAS RD, WALES, WI 53183-9778
(262) 893-8079
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
15002-33
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
15002-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1649038258
—
WI
Enumeration date
03/08/2024
Last updated
06/18/2024
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