Provider Demographics
NPI:1316279078
Name:HENDERSON, ADRIANA WANI
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:WANI
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 S JAMAICA CT STE 275
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-4604
Mailing Address - Country:US
Mailing Address - Phone:303-337-4920
Mailing Address - Fax:303-337-2025
Practice Address - Street 1:3000 S JAMAICA CT STE 275
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-4604
Practice Address - Country:US
Practice Address - Phone:303-337-4920
Practice Address - Fax:303-337-2025
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10H565376J00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000146693Medicaid