Individual
SHALISA ANNE HENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209007259
IL
367A00000X
Advanced Practice Midwife
2019040165
MO
367A00000X
Advanced Practice Midwife
Primary
209017353
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
207988
MEDICARE GROUP NUMBER
IL
01
—
207988001
MEDICARE PTAN NUMBER
IL
01
—
CG2264
RR GROUP ID
IL
01
—
P00651305
RAILROAD MEDICARE
IL
Enumeration date
09/10/2008
Last updated
05/21/2024
Update your record
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