Provider Demographics
NPI:1356855118
Name:HENDERSON, RENEE DENISE
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:DENISE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14534 REDFORD DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-5763
Mailing Address - Country:US
Mailing Address - Phone:313-303-6445
Mailing Address - Fax:
Practice Address - Street 1:14534 REDFORD DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-5763
Practice Address - Country:US
Practice Address - Phone:313-303-6445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0000000OtherMEDICARE FOR DME