1184274391 NPI number — JENNIFER J HENDERSON LMT, REIKI MASTER

Table of content: JENNIFER J HENDERSON LMT, REIKI MASTER (NPI 1184274391)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184274391 NPI number — JENNIFER J HENDERSON LMT, REIKI MASTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENDERSON
Provider First Name:
JENNIFER
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMT, REIKI MASTER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HENDERSON
Provider Other First Name:
JEN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMT, REIKI MASTER
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1184274391
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7474 E ARKANSAS AVE APT 1703
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80231-2542
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-964-1579
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4704 HARLAN ST STE 510
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80212-7464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-424-7171
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/19/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MT.0022292 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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