Basic Information
| Provider Information | |||||||||
| NPI: | 1538513023 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HENDERSON | ||||||||
| FirstName: | YOLANDA | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 202 N VINE ST | ||||||||
| Address2: | |||||||||
| City: | BASTROP | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712203749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182814195 | ||||||||
| FaxNumber: | 3182812196 | ||||||||
| Practice Location | |||||||||
| Address1: | 202 N VINE ST | ||||||||
| Address2: | |||||||||
| City: | BASTROP | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712203749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182814195 | ||||||||
| FaxNumber: | 3182812196 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2016 | ||||||||
| LastUpdateDate: | 04/25/2016 | ||||||||
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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 | RN110767 | LA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.