Individual
LISA L HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2239 E COOK ST, SPRINGFIELD, IL 62703-1944
(217) 788-2300
(217) 788-2342
Mailing address
2239 E COOK ST, SPRINGFIELD, IL 62703-1944
(217) 788-2300
(217) 788-2342
Taxonomy
Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
041206559
IL
363LF0000X
Family Nurse Practitioner
Primary
209014399
IL
Other
Enumeration date
03/03/2016
Last updated
09/08/2016
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