Individual
MR. ETHAN M HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
3231 S NATIONAL AVE STE 170, SPRINGFIELD, MO 65807-7304
(417) 885-0868
Mailing address
3231 S NATIONAL AVE STE 170, SPRINGFIELD, MO 65807-7304
(417) 885-0868
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2019007535
MO
Other
Enumeration date
05/22/2019
Last updated
06/19/2019
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