Provider Demographics
NPI:1790446078
Name:HENDERSON, CHERON M (LPN)
Entity Type:Individual
Prefix:
First Name:CHERON
Middle Name:M
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 ALAMEDA PL
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-4511
Mailing Address - Country:US
Mailing Address - Phone:937-242-1900
Mailing Address - Fax:
Practice Address - Street 1:525 ALAMEDA PL
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-4511
Practice Address - Country:US
Practice Address - Phone:937-242-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care