Provider Demographics
NPI:1538837067
Name:HENSON, LISA DENISE (LPN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:DENISE
Last Name:HENSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:DENISE
Other - Last Name:HENSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2210 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76701-1019
Mailing Address - Country:US
Mailing Address - Phone:254-755-6411
Mailing Address - Fax:254-755-6422
Practice Address - Street 1:2210 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76701-1019
Practice Address - Country:US
Practice Address - Phone:254-755-6411
Practice Address - Fax:254-755-6422
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX145826164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse