MEDICARE: ZOA HENDERSON BSN, RN

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	163WC0400X	Case Management Registered Nurse	402735	TN

General Provider Information

NPI Number	:	1801592670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZOA HENDERSON BSN, RN

Provider Business Mailing Address
First Line	:	516 HINCH ST
Second Line	:
City	:	SPRING CITY
State	:	TN
Zip	:	37381-5213
Country	:	US
Telephone Number	:	614-353-5312
Fax Number	:

Provider Business Practice Location Address
First Line	:	516 HINCH ST
Second Line	:
City	:	SPRING CITY
State	:	TN
Zip	:	37381-5213
Country	:	US
Telephone Number	:	614-353-5312
Fax Number	:

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

Provider Enumeration Date	:	02/03/2023
Last Update Date	:	02/03/2023

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