Doctor Name: | DR. COURTNEY LYNETTE HENDERSON |
NPI Number: | 1073678355 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | 0101239024 |
Business Practice Address: | 943 Hualapai Way Peach Springs, AZ - 86434 |
Business Phone Number: | 9287692900 |
Business Fax Number: | |
Mailing Address: | 5327 High Wheels Ct, COLUMBIA |
State: | MD |
Postal Code: | 210445719 |
Phone Number: | 3015963707 |
Fax Number: | |
NPI Enumeration Date: | 12/27/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 0101239024 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |