Provider Demographics
NPI:1144737248
Name:HENSON, JENNIFER (RN, CHC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HENSON
Suffix:
Gender:F
Credentials:RN, CHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:FLORA
Mailing Address - State:IL
Mailing Address - Zip Code:62839-1068
Mailing Address - Country:US
Mailing Address - Phone:618-919-0517
Mailing Address - Fax:
Practice Address - Street 1:929 STACEY BURK DR
Practice Address - Street 2:
Practice Address - City:FLORA
Practice Address - State:IL
Practice Address - Zip Code:62839-3241
Practice Address - Country:US
Practice Address - Phone:618-662-2191
Practice Address - Fax:618-662-2191
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041349142163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse