Provider Demographics
NPI:1104988153
Name:HENDLEY, MARK A (CASE MANAGER)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:HENDLEY
Suffix:
Gender:M
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 CANYON DR
Mailing Address - Street 2:
Mailing Address - City:RATON
Mailing Address - State:NM
Mailing Address - Zip Code:87740-3756
Mailing Address - Country:US
Mailing Address - Phone:505-445-2754
Mailing Address - Fax:505-445-2225
Practice Address - Street 1:220 4TH AVE
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740-2643
Practice Address - Country:US
Practice Address - Phone:505-445-2754
Practice Address - Fax:505-445-2225
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist