Provider Demographics
NPI:1760289177
Name:HENDERSON, CRISTYLE SHAMAR
Entity type:Individual
Prefix:
First Name:CRISTYLE
Middle Name:SHAMAR
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S 19TH ST APT 405
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-1344
Mailing Address - Country:US
Mailing Address - Phone:402-609-8071
Mailing Address - Fax:
Practice Address - Street 1:100 S 19TH ST APT 405
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-1344
Practice Address - Country:US
Practice Address - Phone:402-609-8071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant