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General NPI Number Information
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NPI Number | 1083931968
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Entity Type | Individual
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Provider Name | SANDRA LEE HENDRICKSON GERIATRIC NURSE PRAC
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Gender | Female
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Dates
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Enumeration Date | 04/30/2010
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Last Update Date | 11/20/2015
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Provider Practice Location Address
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Address Line | 1011 CASS ST STE 107
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City | MONTEREY
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State | CA
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Zip | 93940-4542
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Country | US
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Telephone | 831-324-0416
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Fax |
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Provider Business Mailing Address
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Address Line | 284 FOREST RIDGE RD
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City | MONTEREY
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State | CA
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Zip | 93940-4101
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Country | US
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Telephone | 831-236-5802
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 2242
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License Number State | CA
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