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General NPI Number Information
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NPI Number | 1497062590
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Entity Type | Individual
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Provider Name | AMANDA FAYE HENDERSON RN, BSN
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Gender | Female
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Dates
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Enumeration Date | 09/10/2010
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Last Update Date | 09/10/2010
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Provider Practice Location Address
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Address Line | 921 E 3RD ST
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City | CHATTANOOGA
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State | TN
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Zip | 37403-2102
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Country | US
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Telephone | 423-209-8050
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Fax | 423-209-8051
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Provider Business Mailing Address
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Address Line | 1300 SIDE CREEK WAY #207
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City | CHATTANOOGA
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State | TN
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Zip | 37421-7911
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Country | US
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Telephone | 270-282-3013
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | RN0000177425
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License Number State | TN
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