Healthcare Provider Details

I. General information

NPI: 1043613854
Provider Name (Legal Business Name): NANCY LORRAINE HENDRICKS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6508 DEER POINTE DR SUITE A
SALISBURY MD
21804-1668
US

IV. Provider business mailing address

107 OLD STANDISH RD
BUXTON ME
04093-3302
US

V. Phone/Fax

Practice location:
  • Phone: 410-543-1957
  • Fax:
Mailing address:
  • Phone: 207-727-5245
  • Fax: 207-727-4016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP141068
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: