Provider Demographics
NPI:1801867585
Name:HENDERSON, BERNARDINE C (NP)
Entity Type:Individual
Prefix:
First Name:BERNARDINE
Middle Name:C
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30170
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-7170
Mailing Address - Country:US
Mailing Address - Phone:302-623-7362
Mailing Address - Fax:302-623-7374
Practice Address - Street 1:3506 KENNETT PIKE
Practice Address - Street 2:PAIN MANAGEMENT & REHABILATATIVE INSTITUTE
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19807-3019
Practice Address - Country:US
Practice Address - Phone:302-661-3070
Practice Address - Fax:302-661-3080
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG0000180363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00303011OtherRAILROAD MEDICARE
DE1801867585Medicaid
P00303011OtherRAILROAD MEDICARE
DEP20594Medicare UPIN