Individual
KAREN J HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
109 W BLAND ST, ROSWELL, NM 88203-5708
(505) 623-1480
Mailing address
PO BOX 1978, ROSWELL, NM 88202-1978
(505) 623-1480
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
R21381
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
77456581
—
NM
Enumeration date
08/31/2006
Last updated
07/08/2007
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