Provider Demographics
NPI:1467802017
Name:HENDERSON, LATEISHA (BBT)
Entity Type:Individual
Prefix:
First Name:LATEISHA
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:BBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WHITMORE RD APT 403
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48203-1748
Mailing Address - Country:US
Mailing Address - Phone:313-603-7039
Mailing Address - Fax:
Practice Address - Street 1:900 WHITMORE RD APT 403
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48203-1748
Practice Address - Country:US
Practice Address - Phone:313-603-7039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information