Provider Demographics
NPI:1003896622
Name:HENDERSON, LOIS MARIA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:MARIA
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7060
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-7060
Mailing Address - Country:US
Mailing Address - Phone:480-444-2017
Mailing Address - Fax:480-545-7181
Practice Address - Street 1:1076 W CHANDLER BLVD
Practice Address - Street 2:SUITE 113
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5225
Practice Address - Country:US
Practice Address - Phone:480-963-9334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN048261363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP59356Medicare UPIN
AZ70243Medicare ID - Type Unspecified