Healthcare Provider Details

I. General information

NPI: 1295082030
Provider Name (Legal Business Name): RENEE HENDRICK ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2012
Last Update Date: 03/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E MICHIGAN AVE
JACKSON MI
49201-2457
US

IV. Provider business mailing address

900 E MICHIGAN AVE
JACKSON MI
49201-2457
US

V. Phone/Fax

Practice location:
  • Phone: 517-788-7866
  • Fax:
Mailing address:
  • Phone: 517-788-7866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704149226
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: