Provider Demographics
NPI:1013286830
Name:HENDERSON, LORENA CARRILLO (RN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:LORENA
Middle Name:CARRILLO
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:RN, FNP-C
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Mailing Address - Street 1:7248 CANYON WREN AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79911-3067
Mailing Address - Country:US
Mailing Address - Phone:915-613-7716
Mailing Address - Fax:855-710-7290
Practice Address - Street 1:4301 N MESA ST STE 100
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1118
Practice Address - Country:US
Practice Address - Phone:915-613-7716
Practice Address - Fax:855-710-7290
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMCNP-02601363LP2300X
TX607418363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care