Provider Demographics
NPI:1669102398
Name:HENDERSON, DARIN LAWRENCE
Entity type:Individual
Prefix:
First Name:DARIN
Middle Name:LAWRENCE
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:ND
Mailing Address - Zip Code:58653-5326
Mailing Address - Country:US
Mailing Address - Phone:701-580-0657
Mailing Address - Fax:
Practice Address - Street 1:404 1ST AVE N
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:ND
Practice Address - Zip Code:58653-5326
Practice Address - Country:US
Practice Address - Phone:701-580-0657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant