Healthcare Provider Details

I. General information

NPI: 1033089693
Provider Name (Legal Business Name): GLENNIS HENDERSON
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 11/10/2025
Certification Date: 11/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 NE CAMPUS PKWY
SEATTLE WA
98195-0003
US

IV. Provider business mailing address

1410 NE CAMPUS PKWY
SEATTLE WA
98195-0003
US

V. Phone/Fax

Practice location:
  • Phone: 206-543-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: