Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 115605 | KS |
Y | 363L00000X | Nurse Practitioner | 78024 | KS |
NPI | 1003311887 |
---|---|
Provider Name | Angela M Henderlong |
First Address | Topeka, KS 66606-2442 |
Second Address | Topeka, KS 66606-2442 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2018 |
Last Update Date | 13/07/2021 |