Individual
MRS. LISA RENEE HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP-C
Contact information
Practice address
415 SIXTH ST., CARDIOLOGY DEPARTMENT, LEWISTON, ID 83501-4255
(208) 750-7507
(208) 750-7384
Mailing address
415 6TH ST, LEWISTON, ID 83501-2431
(208) 750-7445
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
57109
ID
Other
Enumeration date
10/26/2017
Last updated
11/14/2019
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