Healthcare Provider Details

I. General information

NPI: 1679589386
Provider Name (Legal Business Name): ELIZABETH T. HENDERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8308 CONSTITUTION PL NE
ALBUQUERQUE NM
87110-7637
US

IV. Provider business mailing address

8308 CONSTITUTION PL NE
ALBUQUERQUE NM
87110-7637
US

V. Phone/Fax

Practice location:
  • Phone: 505-883-9570
  • Fax:
Mailing address:
  • Phone: 505-883-9570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number97-74
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: