Healthcare Provider Details

I. General information

NPI: 1093630196
Provider Name (Legal Business Name): MICHELE HENDRICKSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 MONTEREY RD
ATASCADERO CA
93422-2429
US

IV. Provider business mailing address

3700 MONTEREY RD
ATASCADERO CA
93422-2429
US

V. Phone/Fax

Practice location:
  • Phone: 805-440-5170
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95039255
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: