Provider Demographics
NPI:1922772896
Name:HENDERSON, JANE
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:
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 229
Mailing Address - Street 2:
Mailing Address - City:AMELIA COURT HOUSE
Mailing Address - State:VA
Mailing Address - Zip Code:23002-0229
Mailing Address - Country:US
Mailing Address - Phone:804-561-2481
Mailing Address - Fax:804-561-3224
Practice Address - Street 1:16360 DUNN ST STE 202
Practice Address - Street 2:
Practice Address - City:AMELIA COURT HOUSE
Practice Address - State:VA
Practice Address - Zip Code:23002-4807
Practice Address - Country:US
Practice Address - Phone:804-561-2481
Practice Address - Fax:804-561-3224
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator