Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 607418 | TX |
N | 363LP2300X | Nurse Practitioner - Primary Care | CNP-02601 | NM |
NPI | 1013286830 |
---|---|
Provider Name | Mrs. Lorena Carrillo Henderson |
First Address | El Paso, TX 79911-3067 |
Second Address | El Paso, TX 79902-1118 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2011 |
Last Update Date | 10/01/2022 |