Provider Demographics
NPI:1336316330
Name:HENDERSON, JANICE K (RN, CANP)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:K
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:RN, CANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6795 E TENNESSEE AVE # 427
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-1614
Mailing Address - Country:US
Mailing Address - Phone:303-458-1085
Mailing Address - Fax:
Practice Address - Street 1:6795 E TENNESSEE AVE # 427
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-1614
Practice Address - Country:US
Practice Address - Phone:303-458-1085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0177482-21363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO47122OtherCOLORADO DEPT OF REGULATORY AGENCIES
CO0177482-21OtherAMERICAN NURSES CREDENTIALING CENTER