Provider Demographics
NPI:1194194621
Name:HENDERSON, ROBERT
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 CAMDEN YARDS WAY
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-8777
Mailing Address - Country:US
Mailing Address - Phone:919-244-7545
Mailing Address - Fax:
Practice Address - Street 1:100 PARKWAY OFFICE CT
Practice Address - Street 2:SUITE 202
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7437
Practice Address - Country:US
Practice Address - Phone:919-239-4805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8689251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health