Provider Demographics
NPI:1750598645
Name:HENDERSON-ALLEN, DALE SHERI
Entity type:Individual
Prefix:MRS
First Name:DALE
Middle Name:SHERI
Last Name:HENDERSON-ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 ACOMA DR
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-2103
Mailing Address - Country:US
Mailing Address - Phone:513-336-9858
Mailing Address - Fax:
Practice Address - Street 1:201 ACOMA DR
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-2103
Practice Address - Country:US
Practice Address - Phone:513-336-9858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN109194164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2706905Medicaid