Individual
CHRISTY M. HENDERSON-PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
1721 HAMMER LANE SUITE A, STOCKTON, CA 95210-4116
(209) 751-5200
Mailing address
PO BOX 779, STOCKTON, CA 95201
(209) 373-2829
(209) 373-2873
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
NP11839
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NP11839
LICENSE
CA
Enumeration date
10/18/2006
Last updated
02/01/2013
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