Healthcare Provider Details

I. General information

NPI: 1871950527
Provider Name (Legal Business Name): STEPHEN MICHAEL HENDRICKSON ACNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2016
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 MEDICAL DR
SAN ANTONIO TX
78229-4402
US

IV. Provider business mailing address

7703 FLOYD CURL DR
SAN ANTONIO TX
78229-3901
US

V. Phone/Fax

Practice location:
  • Phone: 210-743-0936
  • Fax: 210-949-3006
Mailing address:
  • Phone: 210-743-0936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP129541
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: