| Doctor Name: | MRS. TAMMIE HENDERSON |
| NPI Number: | 1598164303 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | N.P. |
| License Number: | 209011570 |
| Business Practice Address: | 400 S Kennedy Dr Suite 900 Bradley, IL - 609152682 |
| Business Phone Number: | 8159323132 |
| Business Fax Number: | 8159322397 |
| Mailing Address: | 400 S Kennedy Dr, Suite 900 BRADLEY |
| State: | IL |
| Postal Code: | 609152682 |
| Phone Number: | 8159323132 |
| Fax Number: | 8159322397 |
| NPI Enumeration Date: | 08/18/2014 |
| NPI Last Update Date: | 08/18/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 209011570 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |