Provider Demographics
NPI:1023396827
Name:HENDERSON, MONIQUE DANIELLE
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:DANIELLE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8620 S EASTERN AVE
Mailing Address - Street 2:#16
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123
Mailing Address - Country:US
Mailing Address - Phone:702-992-0576
Mailing Address - Fax:702-992-0391
Practice Address - Street 1:601 ALLISTON CT
Practice Address - Street 2:#16
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-4413
Practice Address - Country:US
Practice Address - Phone:702-992-0576
Practice Address - Fax:702-992-0391
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency