Provider Demographics
NPI:1508094699
Name:HENDERSON, AMBER L (MD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:L
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 MARTIN LUTHER KING JR. WAY
Mailing Address - Street 2:TACOMA FAMILY MEDICINE RESIDENCY PROGRAM (MULTICARE HEA
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4238
Mailing Address - Country:US
Mailing Address - Phone:253-403-2938
Mailing Address - Fax:253-403-2968
Practice Address - Street 1:521 MARTIN LUTHER KING JR. WAY
Practice Address - Street 2:TACOMA FAMILY MEDICINE RESIDENCY PROGRAM (MULTICARE HEA
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4238
Practice Address - Country:US
Practice Address - Phone:253-403-2938
Practice Address - Fax:253-403-2968
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program