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NPI Code Detail

MEDICARE: LATARSHA HENDERSON RN

MEDICARE: LATARSHA HENDERSON RN
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
1163W00000XRegistered NurseR198935MD

General Provider Information

NPI Number : 1306510979
Entity Type Code : Individual
Provider Name (Legal Business Name) : LATARSHA HENDERSON RN
Provider Business Mailing Address
First Line : 10440 LITTLE PATUXENT PKWY STE 800
Second Line :
City : COLUMBIA
State : MD
Zip : 21044-3569
Country : US
Telephone Number : 443-939-6893
Fax Number :
Provider Business Practice Location Address
First Line : 10440 LITTLE PATUXENT PKWY STE 800
Second Line :
City : COLUMBIA
State : MD
Zip : 21044-3569
Country : US
Telephone Number : 443-939-6893
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2021
Last Update Date : 08/05/2021

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