Individual
DESTINY NICOLE HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
59 GRANT ST, NEWARK, OH 43055-3939
(740) 349-7511
Mailing address
1801 WATERMARK DR, COLUMBUS, OH 43215-7088
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/01/2024
Last updated
05/01/2024
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