MEDICARE: HEIDI HENDERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZA2600X	Medical Art Specialist/Technologist

General Provider Information

NPI Number	:	1235791161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI HENDERSON

Provider Business Mailing Address
First Line	:	4700 MISTY CT
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93309-4739
Country	:	US
Telephone Number	:	661-444-7397
Fax Number	:

Provider Business Practice Location Address
First Line	:	10606 HAGEMAN RD STE B4
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93312-9109
Country	:	US
Telephone Number	:	661-444-7397
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2019
Last Update Date	:	11/01/2021

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Directions to “ HEIDI HENDERSON ” Practice Location

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