Provider Demographics
NPI:1083162762
Name:HENDERSON, MICHELLE (RNFA, CNOR, RN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:RNFA, CNOR, RN
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ADAMSON
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1175 COUNTY ROAD 459
Mailing Address - Street 2:
Mailing Address - City:HEFLIN
Mailing Address - State:AL
Mailing Address - Zip Code:36264-4090
Mailing Address - Country:US
Mailing Address - Phone:770-846-9526
Mailing Address - Fax:
Practice Address - Street 1:1175 COUNTY ROAD 459
Practice Address - Street 2:
Practice Address - City:HEFLIN
Practice Address - State:AL
Practice Address - Zip Code:36264-4090
Practice Address - Country:US
Practice Address - Phone:770-846-9526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-12
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN217566163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant