MEDICARE: ANGELA M. HENDERSON BSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	141790	TN

General Provider Information

NPI Number	:	1215063995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA M. HENDERSON BSN

Provider Business Mailing Address
First Line	:	1008 MOUNT ZION RD
Second Line	:	P.O. BOX 248
City	:	UNION CITY
State	:	TN
Zip	:	38261-7694
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1008 MOUNT ZION RD
Second Line	:
City	:	UNION CITY
State	:	TN
Zip	:	38261-7694
Country	:	US
Telephone Number	:	731-885-5294
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/08/2007

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