Provider Demographics
NPI:1457124794
Name:HENDERSON, JOAN IRENE
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:IRENE
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 1:301 COURTYARD LN BLDG 3
Mailing Address - Street 2:
Mailing Address - City:AMELIA
Mailing Address - State:OH
Mailing Address - Zip Code:45102-6500
Mailing Address - Country:US
Mailing Address - Phone:513-560-8912
Mailing Address - Fax:
Practice Address - Street 1:301 COURTYARD LN BLDG 3
Practice Address - Street 2:
Practice Address - City:AMELIA
Practice Address - State:OH
Practice Address - Zip Code:45102-6500
Practice Address - Country:US
Practice Address - Phone:513-560-8912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker