Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | APN.0990650-NP | CO |
N | 363LG0600X | Nurse Practitioner - Gerontology | APN.0990650-NP | CO |
NPI | 1033558101 |
---|---|
Provider Name | Tessa Suzanne Henderson |
First Address | Englewood, CO 80112-3861 |
Second Address | Englewood, CO 80112-3861 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2013 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
384572YQ3L | MEDICARE (01) | CO |
384572YQN9 | MEDICARE (01) | CO |
384572YQPG | MEDICARE (01) | CO |