Healthcare Provider Details

I. General information

NPI: 1609223312
Provider Name (Legal Business Name): CINDY HENSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N YORK AVE
HAGERMAN NM
88232-9632
US

IV. Provider business mailing address

310 N YORK AVE
HAGERMAN NM
88232-9632
US

V. Phone/Fax

Practice location:
  • Phone: 575-910-6265
  • Fax:
Mailing address:
  • Phone: 575-910-6265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR35787
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: