Provider Demographics
NPI:1780480731
Name:HENDERSON, KARIZMA TYTIANNA
Entity type:Individual
Prefix:MS
First Name:KARIZMA
Middle Name:TYTIANNA
Last Name:HENDERSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 13TH ST NE UNIT 4
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-9064
Mailing Address - Country:US
Mailing Address - Phone:202-640-0710
Mailing Address - Fax:
Practice Address - Street 1:423 13TH ST NE UNIT 4
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-9064
Practice Address - Country:US
Practice Address - Phone:202-640-0710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant