MEDICARE: BIBI S HENDERSON RN BSN

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	163W00000X	Registered Nurse	572456-1	NY

General Provider Information

NPI Number	:	1881147007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BIBI S HENDERSON RN BSN

Provider Business Mailing Address
First Line	:	9418 110TH ST
Second Line	:
City	:	SOUTH RICHMOND HILL
State	:	NY
Zip	:	11419-1015
Country	:	US
Telephone Number	:	646-667-5163
Fax Number	:

Provider Business Practice Location Address
First Line	:	9418 110TH ST
Second Line	:
City	:	SOUTH RICHMOND HILL
State	:	NY
Zip	:	11419-1015
Country	:	US
Telephone Number	:	646-667-5163
Fax Number	:

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

Provider Enumeration Date	:	07/25/2016
Last Update Date	:	08/03/2016

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