Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 5101018380 | MI |
NPI | 1013147701 |
---|---|
Provider Name | Dr. Jennifer L Henderson |
First Address | Pontiac, MI 48341-5031 |
Second Address | Pontiac, MI 48341-5031 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2009 |
Last Update Date | 12/07/2013 |