Provider Demographics
NPI:1992545560
Name:HENDERSON, TAMIKA RASHUNNE (FULL SPECTRUM DOULA)
Entity type:Individual
Prefix:
First Name:TAMIKA
Middle Name:RASHUNNE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:FULL SPECTRUM DOULA
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BIRTHWORKER
Mailing Address - Street 1:3700 CRESCENT CT
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-2111
Mailing Address - Country:US
Mailing Address - Phone:414-937-0314
Mailing Address - Fax:
Practice Address - Street 1:3700 CRESCENT CT
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-2111
Practice Address - Country:US
Practice Address - Phone:414-937-0314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker