Provider Demographics
NPI:1316434590
Name:HENDERSON, ANGELA MARIE
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
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 1:511 WOODLORE DR
Mailing Address - Street 2:
Mailing Address - City:CHICKASAW
Mailing Address - State:AL
Mailing Address - Zip Code:36611-1669
Mailing Address - Country:US
Mailing Address - Phone:228-263-4899
Mailing Address - Fax:
Practice Address - Street 1:511 WOODLORE DR
Practice Address - Street 2:
Practice Address - City:CHICKASAW
Practice Address - State:AL
Practice Address - Zip Code:36611-1669
Practice Address - Country:US
Practice Address - Phone:228-263-4899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health