Provider Demographics
NPI:1700613916
Name:HENDERSON, CALI ELIZABETH (RN, LMT)
Entity type:Individual
Prefix:
First Name:CALI
Middle Name:ELIZABETH
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1589
Mailing Address - Street 2:
Mailing Address - City:EL PRADO
Mailing Address - State:NM
Mailing Address - Zip Code:87529-1589
Mailing Address - Country:US
Mailing Address - Phone:575-776-1117
Mailing Address - Fax:575-776-1119
Practice Address - Street 1:98 STATE HIGHWAY 150, SUITE 7
Practice Address - Street 2:
Practice Address - City:EL PRADO
Practice Address - State:NM
Practice Address - Zip Code:87529-1589
Practice Address - Country:US
Practice Address - Phone:575-776-1117
Practice Address - Fax:575-776-1119
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMT-2024-01-05174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist