Individual
WILLIE FAYE HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2073 OLYMPIC ST, SUITE 301, SPRINGFIELD, OR 97477-3413
(541) 682-3550
Mailing address
2073 OLYMPIC ST, SPRINGFIELD, OR 97477-3413
(541) 682-3550
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
6560
OR
Other
Enumeration date
07/09/2012
Last updated
07/09/2012
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