Basic Information
Provider Information
NPI: 1033558101
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HENDERSON
FirstName: TESSA
MiddleName: SUZANNE
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: MEUNIER, HOULE
OtherFirstName: TESSA
OtherMiddleName: SUZANNE
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 10700 E. GEDDES AVE
Address2: SUITE 200
City: ENGLEWOOD
State: CO
PostalCode: 801123861
CountryCode: US
TelephoneNumber: (303) 761-9190
FaxNumber: 7208744462
Practice Location
Address1: 10700 E GEDDES AVE STE 200
Address2:  
City: ENGLEWOOD
State: CO
PostalCode: 801123861
CountryCode: US
TelephoneNumber: 3037619190
FaxNumber: 7208744462
Other Information
ProviderEnumerationDate: 06/21/2013
LastUpdateDate: 08/22/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAPN.0990650-NPCOY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
363LG0600XAPN.0990650-NPCON Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology

ID Information
IDTypeStateIssuerDescription
384572YQ3L01COMEDICAREOTHER
384572YQN901COMEDICAREOTHER
384572YQPG01COMEDICAREOTHER


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