Provider Demographics
NPI:1720893712
Name:HENDERSON, ALEXANDRA IMANI
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:IMANI
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 1:8519 OLD HARFORD RD APT A
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-3921
Mailing Address - Country:US
Mailing Address - Phone:443-632-8573
Mailing Address - Fax:
Practice Address - Street 1:3031 ADAMS ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-1508
Practice Address - Country:US
Practice Address - Phone:202-526-1830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-08
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant