Provider Demographics
NPI:1871139006
Name:HENDERSON, LATASHA (RN)
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 532
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:TX
Mailing Address - Zip Code:75568-0532
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 TOWER LN
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:TX
Practice Address - Zip Code:75568-5827
Practice Address - Country:US
Practice Address - Phone:903-371-2177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX975462163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse