MEDICARE: DONNA LYNN HENDERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	161732	OH

General Provider Information

NPI Number	:	1033003678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA LYNN HENDERSON

Provider Business Mailing Address
First Line	:	8729 MOONLIGHT DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-4173
Country	:	US
Telephone Number	:	513-834-1769
Fax Number	:

Provider Business Practice Location Address
First Line	:	5280 KINDLEWOOD DR
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-5565
Country	:	US
Telephone Number	:	513-895-1040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2025
Last Update Date	:	06/18/2025

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