Healthcare Provider Details

I. General information

NPI: 1114992930
Provider Name (Legal Business Name): KATINA LENEIL HENDERSON R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR
FT CARSON CO
80913-4603
US

IV. Provider business mailing address

1650 COCHRANE CIR
FT CARSON CO
80913-4603
US

V. Phone/Fax

Practice location:
  • Phone: 719-524-2047
  • Fax: 719-524-3526
Mailing address:
  • Phone: 719-526-7649
  • Fax: 719-526-7019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number116976
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: