Provider Demographics
NPI:1942359740
Name:HENDERSON, JANEEN D (CNP)
Entity Type:Individual
Prefix:
First Name:JANEEN
Middle Name:D
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2262 N STATE COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-1361
Mailing Address - Country:US
Mailing Address - Phone:714-990-2900
Mailing Address - Fax:714-990-3133
Practice Address - Street 1:2262 N STATE COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-1361
Practice Address - Country:US
Practice Address - Phone:714-990-2900
Practice Address - Fax:714-990-3133
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA317724163WW0101X
CANP5683363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
Not Answered363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS77744Medicare UPIN
CAWNP5683AMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER