Provider Demographics
NPI:1649773227
Name:HENDERSON, ROBIN GAIL (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:GAIL
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13143 GABAY CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-9400
Mailing Address - Country:US
Mailing Address - Phone:909-809-9510
Mailing Address - Fax:
Practice Address - Street 1:69780 STELLAR DR
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-2954
Practice Address - Country:US
Practice Address - Phone:760-424-3380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008044363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily