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Individual
SHANNON HENDERSON
Active
Individual
SHANNON HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
202004735NP-PP
OR
363L00000X
Nurse Practitioner
5009257
NC
Other
Enumeration date
10/04/2012
Last updated
06/17/2020
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