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Individual

AMY R HENDERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
9951 ROCK CUT XING, LOVES PARK, IL 61111-1999
(815) 639-8500
(815) 639-8501
Mailing address
9951 ROCK CUT XING, LOVES PARK, IL 61111-1999
(815) 639-8500
(815) 639-8501

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085006656
IL

Other

Enumeration date
07/24/2018
Last updated
07/24/2018
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