Individual
SHAUNTELLE HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
312 W 52ND PL, CHICAGO, IL 60609-6229
(773) 956-4603
Mailing address
304 S JONES BLVD # 2440, LAS VEGAS, NV 89107-2623
(708) 506-1536
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043.089473
IL
251J00000X
Nursing Care Agency
043.089473
IL
305S00000X
Point of Service
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1215698527
AMOUR -PROPRE AESTHETE COLLECTIVE
IL
Enumeration date
07/23/2021
Last updated
01/09/2022
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