Provider Demographics
NPI:1871991893
Name:HENDERSON, EMILY ELISE (MB BCH BAO)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:ELISE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MB BCH BAO
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:ELISE
Other - Last Name:WAKELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9505 S STEELE ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-1858
Mailing Address - Country:US
Mailing Address - Phone:253-597-6800
Mailing Address - Fax:253-597-6888
Practice Address - Street 1:9505 S STEELE ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-1858
Practice Address - Country:US
Practice Address - Phone:253-597-6800
Practice Address - Fax:253-597-6888
Is Sole Proprietor?:No
Enumeration Date:2014-12-08
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61023416207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism