Individual
SHIRLEY C HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.N.
Contact information
Practice address
249 COUNTY ROAD 1101, BOONEVILLE, MS 38829-9630
(662) 728-0377
Mailing address
249 COUNTY ROAD 1101, BOONEVILLE, MS 38829-9630
(662) 728-0377
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
P194832
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0077348
—
MS
Enumeration date
04/02/2007
Last updated
07/09/2007
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