Healthcare Provider Details

I. General information

NPI: 1366892929
Provider Name (Legal Business Name): DAWN HENDRICKS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2142 N COVE BLVD
TOLEDO OH
43606-3895
US

IV. Provider business mailing address

1 SEAGATE SUITE 800
TOLEDO OH
43604-1558
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-4000
  • Fax: 419-479-3253
Mailing address:
  • Phone: 567-585-1918
  • Fax: 419-824-7359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number19048NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: