MEDICARE: LISA DENISE HENSON LPN

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	164W00000X	Licensed Practical Nurse	145826	TX

General Provider Information

NPI Number	:	1538837067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA DENISE HENSON LPN

Provider Business Mailing Address
First Line	:	2210 WASHINGTON AVE
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76701-1019
Country	:	US
Telephone Number	:	254-755-6411
Fax Number	:	254-755-6422

Provider Business Practice Location Address
First Line	:	2210 WASHINGTON AVE
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76701-1019
Country	:	US
Telephone Number	:	254-755-6411
Fax Number	:	254-755-6422

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

Provider Enumeration Date	:	08/31/2021
Last Update Date	:	08/31/2021

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