Provider Demographics
NPI:1295033256
Name:HENDERSON, MICHELLE D (CNM)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:D
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:D
Other - Last Name:PEASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:7490 ZIEGLER RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3156
Mailing Address - Country:US
Mailing Address - Phone:423-648-6020
Mailing Address - Fax:813-282-1806
Practice Address - Street 1:7490 ZIEGLER RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3156
Practice Address - Country:US
Practice Address - Phone:423-648-6020
Practice Address - Fax:423-702-9994
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2023-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11011885367A00000X
TN31830367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife