LEA HENDERSON


Address: 731 Lee Dr, Las Vegas, NM 87701-4932
Phone: 5054264042

LEA HENDERSON (NPI# 1497151336) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1497151336
Entity Type Individual
Full Name LEA HENDERSON
Credential NURSE PRACTITIONER
Practice Address 731 Lee Dr
Las Vegas
NM 87701-4932
Practice Telephone 5054264042
Mailing Telephone 5054264042
Enumeration Date 2014-11-04
Last Update Date 2018-09-18
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LF0000X Nurse Practitioner
Specialization: Family
CNP-02556 NM Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
NM 57773734 05

Office Location

Street Address 731 LEE DR
City LAS VEGAS
State NM
Zip Code 87701-4932

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Taxonomy Information

Taxonomy Code 363LF0000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Family

Taxonomy Definition

Definition to come...

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Competitor

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City LAS VEGAS
Zip Code 87701

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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