Healthcare Provider Details

I. General information

NPI: 1942481841
Provider Name (Legal Business Name): AMANDA JOANNE HENDRICKS L.P.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 S PEARL ST
TACOMA WA
98465-2117
US

IV. Provider business mailing address

PO BOX 2436
SILVERDALE WA
98383-2436
US

V. Phone/Fax

Practice location:
  • Phone: 253-396-5930
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberLP00051736
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: