Active NPI
Lori L Henderson, APNP
- Nurse Practitioner
- Racine, WI
National Provider Identifier
1356534143
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 3177
- Practice address
- 3807 Spring St
3Rd Floor-East Wing
Racine, WI 53405-1667 - Phone
- (262) 687-8300
- Fax
- (262) 687-8797
- NPI assigned
- Aug 24, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 3177 | WI | Primary |
Addresses
Primary practice location
3807 Spring St
3Rd Floor-East Wing
Racine, WI 53405-1667
Mailing address
3807 Spring St
3Rd Floor-East Wing
Racine, WI 53405-1667
Phone (262) 687-8300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3177 | WI | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187913600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187913600000",
"number": "1356534143",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3807 SPRING ST",
"address_2": "3RD FLOOR-EAST WING",
"city": "RACINE",
"state": "WI",
"postal_code": "534051667",
"telephone_number": "262-687-8300",
"fax_number": "262-687-8797"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3807 SPRING ST",
"address_2": "3RD FLOOR-EAST WING",
"city": "RACINE",
"state": "WI",
"postal_code": "534051667",
"telephone_number": "262-687-8300",
"fax_number": "262-687-8797"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "LORI",
"middle_name": "L",
"credential": "APNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-08-24",
"last_updated": "2007-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "WI",
"license": "3177",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Racine, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.