Healthcare Provider Details

I. General information

NPI: 1437835980
Provider Name (Legal Business Name): CAMILLE IMANI HENDRICKS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 WAYNE AVE
BRONX NY
10467-2509
US

IV. Provider business mailing address

4029 BARNES AVE # 3
BRONX NY
10466-4309
US

V. Phone/Fax

Practice location:
  • Phone: 914-426-7699
  • Fax:
Mailing address:
  • Phone: 914-426-7699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number846009
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License Number846009
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: