Provider Demographics
NPI:1619577038
Name:HENDERSON, MONIQUE (PCA)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5002 13TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2805
Mailing Address - Country:US
Mailing Address - Phone:202-290-0771
Mailing Address - Fax:
Practice Address - Street 1:600 BARNES ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-1814
Practice Address - Country:US
Practice Address - Phone:202-905-6446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide