Provider Demographics
NPI:1063564151
Name:HENDERSON, DARLENE ALICE (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:DARLENE
Middle Name:ALICE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21941 SHORE POINTE LN
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2362
Mailing Address - Country:US
Mailing Address - Phone:586-771-2167
Mailing Address - Fax:
Practice Address - Street 1:21941 SHORE POINTE LN
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-2362
Practice Address - Country:US
Practice Address - Phone:586-771-2167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI110672163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health