Shauntelle Henderson, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

043.089473 Issued in IL

Practice address

312 W 52ND PL
Chicago, IL 60609-6229

Phone

(773) 956-4603

NPI assigned

Jul 23, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Amour-Propre Esthete Collective

  • Point of Service
  • Chicago, IL
  • NPI 1215698527

  Nursing Care

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641686400000",
    "number": "1760055008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 S JONES BLVD # 2440",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891072623",
            "telephone_number": "708-506-1536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 W 52ND PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606096229",
            "telephone_number": "773-956-4603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "SHAUNTELLE",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-23",
        "last_updated": "2022-01-09",
        "certification_date": "2022-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "IL",
            "license": "043.089473",
            "primary": false
        },
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "IL",
            "license": "043.089473",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMOUR -PROPRE AESTHETE COLLECTIVE",
            "identifier": "1215698527",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lynn Henderson, PMHNP-BC
• Marguerite J Henderson, LCSW
• Michael Henderson, DPT
• Nia Mkela Henderson, MSMFT
• Patrice L Henderson, M.S.
• Tara Olive Henderson
• Victoria Henderson
• Aaron Nissan Hendizadeh
• Nina M Hendler, DPT
• Sarah Kay Hendred

• Licensed Practical Nurse in Chicago, IL
• Providers in Chicago, IL by specialty
• Licensed Practical Nurse in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.