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NPI Code Detail

MEDICARE: ANITA HENDERSON MD

MEDICARE: ANITA HENDERSON MD
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
1208000000XPediatrics Physician10115NV

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00054853OTHERNVRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1144292129
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANITA HENDERSON MD
Provider Business Mailing Address
First Line : PO BOX 15645
Second Line :
City : LAS VEGAS
State : NV
Zip : 89114-5645
Country : US
Telephone Number : 702-242-7308
Fax Number : 702-240-8790
Provider Business Practice Location Address
First Line : 7061 GRAND MONTECITO PKWY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89149-0287
Country : US
Telephone Number : 702-750-3900
Fax Number : 702-750-3916
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2006
Last Update Date : 02/20/2014

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Directions to “ ANITA HENDERSON MD” Practice Location

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