Provider Demographics
NPI:1578632527
Name:HENDERSON, ERIN J (ARNP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:J
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:J
Other - Last Name:JENNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 11789
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98508-1789
Mailing Address - Country:US
Mailing Address - Phone:360-866-7990
Mailing Address - Fax:360-866-4577
Practice Address - Street 1:3240 14TH AVE NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8509
Practice Address - Country:US
Practice Address - Phone:360-866-7990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007081363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9646159Medicaid
WA1013773Medicaid
WA1013773Medicaid
WA9646159Medicaid
WAG8952134Medicare PIN