Provider Demographics
NPI:1558568246
Name:HENDERSON, NANCY R (MA)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:R
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 HAMMILL LN
Mailing Address - Street 2:STE A
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-1004
Mailing Address - Country:US
Mailing Address - Phone:775-682-4000
Mailing Address - Fax:775-682-4003
Practice Address - Street 1:3735 LAKESIDE DR
Practice Address - Street 2:STE A
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509
Practice Address - Country:US
Practice Address - Phone:775-682-4000
Practice Address - Fax:775-682-4003
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAUD 19 AND HAS 64237600000X
NVA-019231H00000X
NVHAS64231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100504633Medicaid