Individual
HOLLY JO HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
102 PRAIRIE MILLS RD, GOLDEN, IL 62339-1055
(217) 696-4446
Mailing address
183 SATURN DR, HANNIBAL, MO 63401-2398
(573) 795-0849
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209020158
IL
Other
Enumeration date
01/03/2007
Last updated
01/31/2020
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