Basic Information
| Provider Information | |||||||||
| NPI: | 1255589909 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HENDERSON | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NURSE PRACTITIONER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1045 JAMES ST | ||||||||
| Address2: | BROWNELL CENTER FOR BEHAVIORAL HEALTH | ||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132032730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154724471 | ||||||||
| FaxNumber: | 3154224855 | ||||||||
| Practice Location | |||||||||
| Address1: | 1045 JAMES ST | ||||||||
| Address2: | BROWNELL CENTER FOR BEHAVIORAL HEALTH | ||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132032730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154724471 | ||||||||
| FaxNumber: | 3154224855 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2008 | ||||||||
| LastUpdateDate: | 12/21/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 552060 | NY | N | Nursing Service Providers | Registered Nurse | 363LP0808X | F401141 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363L00000X | F401141-1 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.