Provider Demographics
NPI:1518154491
Name:HENDERSON PEDIATRICS, LLP
Entity Type:Organization
Organization Name:HENDERSON PEDIATRICS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KULIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-566-0333
Mailing Address - Street 1:220 E HORIZON DR STE A
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-8001
Mailing Address - Country:US
Mailing Address - Phone:702-566-0333
Mailing Address - Fax:702-566-0315
Practice Address - Street 1:220 E HORIZON DR STE A
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-8001
Practice Address - Country:US
Practice Address - Phone:702-566-0333
Practice Address - Fax:702-566-0315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty