MEDICARE: LAKESHIA QUENIC 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	163W00000X	Registered Nurse	6579420	FL

General Provider Information

NPI Number	:	1336518711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKESHIA QUENIC HENDERSON

Provider Business Mailing Address
First Line	:	1933 GREY FALCON CIR SW
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32962-8609
Country	:	US
Telephone Number	:	772-882-5933
Fax Number	:

Provider Business Practice Location Address
First Line	:	1933 GREY FALCON CIR SW
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32962-8609
Country	:	US
Telephone Number	:	772-882-5933
Fax Number	:

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

Provider Enumeration Date	:	09/16/2015
Last Update Date	:	04/30/2026

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