Individual
MRS. LATEASHA LAKIRA HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3901 PELHAM RD, GREENVILLE, SC 29615-5004
(864) 288-3672
Mailing address
3901 PELHAM RD, GREENVILLE, SC 29615-5004
(864) 288-3672
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
24224
SC
Other
Enumeration date
08/04/2020
Last updated
09/13/2021
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