Provider Demographics
NPI:1609223312
Name:HENSON, CINDY
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:HENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 N YORK AVE
Mailing Address - Street 2:
Mailing Address - City:HAGERMAN
Mailing Address - State:NM
Mailing Address - Zip Code:88232-9632
Mailing Address - Country:US
Mailing Address - Phone:575-910-6265
Mailing Address - Fax:
Practice Address - Street 1:310 N YORK AVE
Practice Address - Street 2:
Practice Address - City:HAGERMAN
Practice Address - State:NM
Practice Address - Zip Code:88232-9632
Practice Address - Country:US
Practice Address - Phone:575-910-6265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR35787163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM46683569Medicaid