Amy R Henderson, PA-C
Physician Assistant in Loves Park, IL. Individual provider (NPI-1).
NPI number1861979700
StatusActive
Last updated in NPPESJul 24, 2018
Details
- NPI
- 1861979700
- Entity type
- Individual (NPI-1)
- Name
- Amy R Henderson
- Credential
- PA-C
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jul 24, 2018
- Last updated
- Jul 24, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 085006656 | IL | Yes |
Practice location
9951 Rock Cut XingLoves Park, IL 61111-1999
Phone 815-639-8500 · Fax 815-639-8501
Mailing address
9951 Rock Cut XingLoves Park, IL 61111-1999
Phone 815-639-8500 · Fax 815-639-8501
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