Healthcare Provider Details

I. General information

NPI: 1609552389
Provider Name (Legal Business Name): VANESSA HENDERSON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR ST SE STE 800
ALBUQUERQUE NM
87106-4912
US

IV. Provider business mailing address

3824 LA CHARLES DR NE
ALBUQUERQUE NM
87111-4116
US

V. Phone/Fax

Practice location:
  • Phone: 505-563-2500
  • Fax:
Mailing address:
  • Phone: 303-489-7447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number53537
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: