Healthcare Provider Details

I. General information

NPI: 1902918600
Provider Name (Legal Business Name): MELINDA ANNE HENDRICKSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVENUE
TACOMA WA
98431-3901
US

IV. Provider business mailing address

MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVENUE
TACOMA WA
98431-0001
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-0895
  • Fax: 253-968-1222
Mailing address:
  • Phone: 253-968-0895
  • Fax: 253-968-1222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD00036897
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: