Provider Demographics
NPI:1417398827
Name:HENDERSON, TERESA MICHELLE (RNFA)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:MICHELLE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:MRS
Other - First Name:TERESA
Other - Middle Name:MICHELLE
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RNFA
Mailing Address - Street 1:10602 SPRINGWOOD SQ
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-4623
Mailing Address - Country:US
Mailing Address - Phone:210-385-7347
Mailing Address - Fax:210-475-3995
Practice Address - Street 1:10602 SPRINGWOOD SQ
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-4623
Practice Address - Country:US
Practice Address - Phone:210-385-7347
Practice Address - Fax:210-475-3995
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-13
Last Update Date:2013-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX713370163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant