Healthcare Provider Details

I. General information

NPI: 1942719240
Provider Name (Legal Business Name): ZACHARY HENDERSON FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2017
Last Update Date: 09/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 INSTITUTE RD
WORCESTER MA
01609-2247
US

IV. Provider business mailing address

100 INSTITUTE RD
WORCESTER MA
01609-2247
US

V. Phone/Fax

Practice location:
  • Phone: 508-831-5520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2306007
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: