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General NPI Number Information
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NPI Number | 1245164532
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Entity Type | Individual
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Provider Name | REBECCA HENDERSON
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Gender | Female
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Dates
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Enumeration Date | 06/11/2026
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Last Update Date | 06/11/2026
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Provider Practice Location Address
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Address Line | 237 DAVIS LAKE RD
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City | LAPEER
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State | MI
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Zip | 48446-1485
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Country | US
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Telephone | 810-667-9132
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Fax | 810-667-0026
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Provider Business Mailing Address
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Address Line | 237 DAVIS LAKE RD
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City | LAPEER
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State | MI
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Zip | 48446-1485
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Country | US
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Telephone | 810-667-9132
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Fax | 810-667-0026
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704308459
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License Number State | MI
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