Provider Demographics
NPI:1720216757
Name:HENDERSON, NEENA SUNFLOWER (LMP)
Entity Type:Individual
Prefix:MRS
First Name:NEENA
Middle Name:SUNFLOWER
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S 333RD ST
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-7359
Mailing Address - Country:US
Mailing Address - Phone:253-661-8685
Mailing Address - Fax:253-661-8768
Practice Address - Street 1:200 S 333RD ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-7359
Practice Address - Country:US
Practice Address - Phone:253-661-8685
Practice Address - Fax:253-661-8768
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015764225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist