Healthcare Provider Details

I. General information

NPI: 1912853573
Provider Name (Legal Business Name): JAMES HENDERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 LAKE AVE N
WORCESTER MA
01655-0002
US

IV. Provider business mailing address

3 CEDAR ST APT 34
WORCESTER MA
01609-2536
US

V. Phone/Fax

Practice location:
  • Phone: 855-862-7763
  • Fax:
Mailing address:
  • Phone: 855-862-7763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN2322176
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: