MEDICARE: MS. CHRISTI M HENDERSON

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	171M00000X	Case Manager/Care Coordinator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659542843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTI M HENDERSON

Provider Business Mailing Address
First Line	:	908 N WEST AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57104-5722
Country	:	US
Telephone Number	:	605-367-4293
Fax Number	:	605-367-5714

Provider Business Practice Location Address
First Line	:	908 N WEST AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57104-5722
Country	:	US
Telephone Number	:	605-367-4293
Fax Number	:	605-367-5714

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

Provider Enumeration Date	:	03/17/2008
Last Update Date	:	03/17/2008

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