Healthcare Provider Details

I. General information

NPI: 1639015852
Provider Name (Legal Business Name): BIANCA HENDERSON
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 N ROSELLE RD STE 800
SCHAUMBURG IL
60195-3186
US

IV. Provider business mailing address

909 RIDGEBROOK RD STE 300
SPARKS MD
21152-9477
US

V. Phone/Fax

Practice location:
  • Phone: 443-383-9300
  • Fax:
Mailing address:
  • Phone: 443-383-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209034816
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: