Basic Information
| Provider Information | |||||||||
| NPI: | 1669710984 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HENDERSON | ||||||||
| FirstName: | WHITNEY | ||||||||
| MiddleName: | ADRIENNE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4450 IDLEWILD LN | ||||||||
| Address2: | |||||||||
| City: | HILLSIDE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601621756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7085471636 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14 LAKE ST | ||||||||
| Address2: | |||||||||
| City: | OAK PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 603022606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083830113 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2013 | ||||||||
| LastUpdateDate: | 01/21/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0000X | 041348884 | IL | N | Nursing Service Providers | Registered Nurse | General Practice | 363LF0000X | 209009973 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.