Individual
PAMELA HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4737 HENRY TOWN RD, SEVIERVILLE, TN 37876-6911
(904) 535-6485
Mailing address
4737 HENRY TOWN RD, SEVIERVILLE, TN 37876-6911
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
117177
AK
Other
Enumeration date
12/09/2016
Last updated
12/09/2016
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