Healthcare Provider Details

I. General information

NPI: 1174460208
Provider Name (Legal Business Name): NATASHA HENDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. NATASHA WANDE

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 VALLEY RD
MIDDLETOWN RI
02842-5234
US

IV. Provider business mailing address

65 VALLEY RD
MIDDLETOWN RI
02842-5234
US

V. Phone/Fax

Practice location:
  • Phone: 401-846-6620
  • Fax:
Mailing address:
  • Phone: 401-846-6620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0812X
TaxonomyCommunity Psychiatric/Mental Health Clinical Nurse Specialist
License Number54333
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: