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General NPI Number Information
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NPI Number | 1043334261
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Entity Type | Individual
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Provider Name | RANDALL WAYNE HENDERSON BC-HIS
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Gender | Male
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 07/18/2014
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Provider Practice Location Address
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Address Line | 10404 W COGGINS DR SUITE 110
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City | SUN CITY
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State | AZ
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Zip | 85351-3437
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Country | US
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Telephone | 623-974-9666
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Fax | 623-974-4813
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Provider Business Mailing Address
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Address Line | 2510 E SUNSET RD UNIT 5-260
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City | LAS VEGAS
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State | NV
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Zip | 89120-3511
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Country | US
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Telephone | 702-798-0113
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Fax | 866-291-5242
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 00729
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number |
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License Number State |
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