Provider Demographics
NPI:1295409126
Name:HENDERSON, ATLEY JNEL (RN)
Entity Type:Individual
Prefix:
First Name:ATLEY
Middle Name:JNEL
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 ROAD S
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:NE
Mailing Address - Zip Code:68460-8855
Mailing Address - Country:US
Mailing Address - Phone:402-710-0722
Mailing Address - Fax:
Practice Address - Street 1:1501 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:NE
Practice Address - Zip Code:68467-4700
Practice Address - Country:US
Practice Address - Phone:402-362-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE75974163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool