MEDICARE: YOLANDA DENISE HENDERSON-CHAMBERS 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
1	163WA2000X	Administrator Registered Nurse	809833	TX

General Provider Information

NPI Number	:	1598144826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOLANDA DENISE HENDERSON-CHAMBERS RN

Provider Business Mailing Address
First Line	:	9109 SAINT BARTS RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-3525
Country	:	US
Telephone Number	:	817-210-2049
Fax Number	:

Provider Business Practice Location Address
First Line	:	9109 SAINT BARTS RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-3525
Country	:	US
Telephone Number	:	817-210-2049
Fax Number	:

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

Provider Enumeration Date	:	05/19/2015
Last Update Date	:	05/19/2015

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