Healthcare Provider Details

I. General information

NPI: 1376318741
Provider Name (Legal Business Name): MEGAN HENDERSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 6TH AVE S
BIRMINGHAM AL
35233-1932
US

IV. Provider business mailing address

1072 OAK TREE RD
HOOVER AL
35244-2604
US

V. Phone/Fax

Practice location:
  • Phone: 205-739-8762
  • Fax:
Mailing address:
  • Phone: 205-739-8762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number1-187712
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: