Provider Demographics
NPI:1023551090
Name:HENDERSON, SARAH (MSN, RN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 PARAGON PARKWAY
Mailing Address - Street 2:SUITE 800
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721
Mailing Address - Country:US
Mailing Address - Phone:828-356-2235
Mailing Address - Fax:
Practice Address - Street 1:157 PARAGON PARKWAY
Practice Address - Street 2:SUITE 800
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721
Practice Address - Country:US
Practice Address - Phone:828-356-2235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC205467163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse