| Doctor Name: | MRS. LORENA CARRILLO HENDERSON |
| NPI Number: | 1013286830 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN, FNP-C |
| License Number: | 607418 |
| Business Practice Address: | 1245 Country Club Rd Suite 200 Santa Teresa, NM - 880089743 |
| Business Phone Number: | 9156137716 |
| Business Fax Number: | |
| Mailing Address: | 1245 Country Club Rd, Suite 200 SANTA TERESA |
| State: | NM |
| Postal Code: | 880089743 |
| Phone Number: | 9156137716 |
| Fax Number: | |
| NPI Enumeration Date: | 12/22/2011 |
| NPI Last Update Date: | 04/24/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 607418 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |