Provider Demographics
NPI:1609552389
Name:HENDERSON, VANESSA (CNP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3824 LA CHARLES DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-4116
Mailing Address - Country:US
Mailing Address - Phone:303-489-7447
Mailing Address - Fax:
Practice Address - Street 1:201 CEDAR ST SE STE 800
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4912
Practice Address - Country:US
Practice Address - Phone:505-563-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM53537363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner