Provider Demographics
NPI:1285163170
Name:HENDERSON, VICTORIA M (FNP)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:M
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3928 S MALTA CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-7426
Mailing Address - Country:US
Mailing Address - Phone:720-251-6494
Mailing Address - Fax:
Practice Address - Street 1:16728 E SMOKY HILL RD UNIT 10D
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-2400
Practice Address - Country:US
Practice Address - Phone:303-766-1006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-06
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0993058363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner