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Individual
SHAUNTELLE HENDERSON
Active
Individual
SHAUNTELLE HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043.089473
IL
251J00000X
Nursing Care Agency
043.089473
IL
305S00000X
Point of Service
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1215698527
AMOUR -PROPRE AESTHETE COLLECTIVE
IL
Enumeration date
07/23/2021
Last updated
01/09/2022
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