Individual
SHANNON HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
520 MEDICAL CENTER DR STE 201, MEDFORD, OR 97504-4334
(541) 789-5711
(541) 789-5710
Mailing address
PO BOX 748157, LOS ANGELES, CA 90074-8157
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
202004735NP-PP
OR
363L00000X
Nurse Practitioner
5009257
NC
Other
Enumeration date
10/04/2012
Last updated
06/17/2020
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