MRS. Lisa Renee Henderson, AGNP-C

NPI #1912419243 in Lewiston, Idaho

Provider Information

NPI Number: 1912419243
Entity Type: Individual
Name: MRS. Lisa Renee Henderson, AGNP-C
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Nurse Practitioner
Credential: AGNP-C
Enumeration Date: Oct 26, 2017
Last Updated: Nov 14, 2019

Practice Location

Address: 415 SIXTH ST.
Address 2: CARDIOLOGY DEPARTMENT
City: Lewiston
State: Idaho
ZIP Code: 83501-4255
Phone: (208) 750-7507

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Nurse Practitioner	363L00000X	Primary

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