Healthcare Provider Details

I. General information

NPI: 1215347380
Provider Name (Legal Business Name): MONICA L. HENDRICKS PSS, WRAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 06/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 HOMER ROAD
MINDEN LA
71055
US

IV. Provider business mailing address

435 HOMER ROAD
MINDEN LA
71055
US

V. Phone/Fax

Practice location:
  • Phone: 318-371-3001
  • Fax: 318-371-3300
Mailing address:
  • Phone: 318-371-3001
  • Fax: 318-371-3300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number11558
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: