Provider Demographics
NPI:1700240991
Name:DENOVO CLINICAL SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:DENOVO CLINICAL SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORENA
Authorized Official - Middle Name:CARRILLO
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN,MSN,FNP-C
Authorized Official - Phone:956-739-1796
Mailing Address - Street 1:1245 COUNTRY CLUB RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-9743
Mailing Address - Country:US
Mailing Address - Phone:575-332-4633
Mailing Address - Fax:575-332-4633
Practice Address - Street 1:1245 COUNTRY CLUB RD STE 200
Practice Address - Street 2:
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9743
Practice Address - Country:US
Practice Address - Phone:575-332-4633
Practice Address - Fax:575-332-4633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02601261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care