Provider Demographics
NPI:1538513023
Name:HENDERSON, YOLANDA (RN)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 N VINE ST
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-3749
Mailing Address - Country:US
Mailing Address - Phone:318-281-4195
Mailing Address - Fax:318-281-2196
Practice Address - Street 1:202 N VINE ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-3749
Practice Address - Country:US
Practice Address - Phone:318-281-4195
Practice Address - Fax:318-281-2196
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN110767163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse