Provider Demographics
NPI:1881000263
Name:HENDERSON, NATALIE ANN (RMA)
Entity Type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:ANN
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:RMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 ADA ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-3354
Mailing Address - Country:US
Mailing Address - Phone:330-322-5869
Mailing Address - Fax:
Practice Address - Street 1:660 ADA ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-3354
Practice Address - Country:US
Practice Address - Phone:330-322-5869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0097677Medicaid