Healthcare Provider Details

I. General information

NPI: 1912930504
Provider Name (Legal Business Name): PATRICIA HENDRICKSON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 TRANSPORT ST SE
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

PO BOX 26028
ALBUQUERQUE NM
87125-6028
US

V. Phone/Fax

Practice location:
  • Phone: 505-254-6500
  • Fax: 505-254-6528
Mailing address:
  • Phone: 505-262-7215
  • Fax: 505-232-1627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR13802
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: