Healthcare Provider Details

I. General information

NPI: 1104829183
Provider Name (Legal Business Name): HENDERSON CLINIC FOR WOMEN PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 RUIN CREEK RD STE 101
HENDERSON NC
27536-5919
US

IV. Provider business mailing address

511 RUIN CREEK RD STE 101
HENDERSON NC
27536-5919
US

V. Phone/Fax

Practice location:
  • Phone: 252-492-8576
  • Fax: 252-492-7464
Mailing address:
  • Phone: 252-492-8576
  • Fax: 252-492-7464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number39877
License Number StateNC

VIII. Authorized Official

Name: MS. NANCY P KING
Title or Position: OFFICE MANAGER
Credential:
Phone: 252-492-8576