Healthcare Provider Details

I. General information

NPI: 1699436667
Provider Name (Legal Business Name): ELLIE ROSE HENDRICKSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2022
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 MERIDIAN ST
BELLINGHAM WA
98225-1732
US

IV. Provider business mailing address

3600 MERIDIAN ST
BELLINGHAM WA
98225-1732
US

V. Phone/Fax

Practice location:
  • Phone: 360-676-6000
  • Fax:
Mailing address:
  • Phone: 360-676-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN61073377
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: