Healthcare Provider Details

I. General information

NPI: 1104758481
Provider Name (Legal Business Name): PENELOPE HENDRICKSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7521 E HAMPSTEAD CT
MIDDLETON WI
53562-3609
US

IV. Provider business mailing address

7521 E HAMPSTEAD CT
MIDDLETON WI
53562-3609
US

V. Phone/Fax

Practice location:
  • Phone: 608-829-9791
  • Fax:
Mailing address:
  • Phone: 608-829-9791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number178743-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: