Provider Demographics
NPI:1508199365
Name:HENDERSON, JUSTIN ERIC (APRN)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:ERIC
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 DATE ST
Mailing Address - Street 2:20C
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-1184
Mailing Address - Country:US
Mailing Address - Phone:808-561-5424
Mailing Address - Fax:
Practice Address - Street 1:619 KAPAHULU AVE
Practice Address - Street 2:PH
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-3853
Practice Address - Country:US
Practice Address - Phone:808-561-5424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1338363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health