Healthcare Provider Details

I. General information

NPI: 1982789558
Provider Name (Legal Business Name): HELEN ELIZABETH HENDRICKSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 CERRILLOS ROAD SUITE #719F
SANTA FE NM
87507-2699
US

IV. Provider business mailing address

223 N GUADALUPE ST # 169
SANTA FE NM
87501-1868
US

V. Phone/Fax

Practice location:
  • Phone: 505-500-4072
  • Fax: 505-216-2219
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD00025654
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD2010-0629
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: