Individual
LORA JELISE HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
801 N BROADWAY, BALTIMORE, MD 21205-1424
(919) 810-4434
Mailing address
4105 RICELAND DR, DURHAM, NC 27705-5383
(919) 810-1932
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
06/07/2018
Last updated
06/07/2018
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