Provider Demographics
NPI:1326626532
Name:HENDERSON HEALTH SERVICES FAMILY NURSE PRACTITIONER SERVICES
Entity Type:Organization
Organization Name:HENDERSON HEALTH SERVICES FAMILY NURSE PRACTITIONER SERVICES
Other - Org Name:HENDERSON HEALTH SERVICES FAMILY NURSE PRACTITIONER PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:SEBRINA
Authorized Official - Middle Name:LEI-LANI
Authorized Official - Last Name:XI-AMARU- HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:914-200-4275
Mailing Address - Street 1:75 S BROADWAY FL 4
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-4413
Mailing Address - Country:US
Mailing Address - Phone:914-200-4275
Mailing Address - Fax:914-236-1031
Practice Address - Street 1:75 S BROADWAY FL 4
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4413
Practice Address - Country:US
Practice Address - Phone:914-200-4275
Practice Address - Fax:914-236-1031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-30
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No251E00000XAgenciesHome Health