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General NPI Number Information
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NPI Number | 1235850991
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Entity Type | Individual
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Provider Name | ANNE KATHERINE HENDRICKS
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Gender | Female
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Dates
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Enumeration Date | 09/09/2022
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Last Update Date | 04/04/2025
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Provider Practice Location Address
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Address Line | 4891 MILLER TRUNK HWY
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City | HERMANTOWN
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State | MN
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Zip | 55811-1512
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Country | US
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Telephone | 218-306-8383
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Fax | 218-875-6315
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Provider Business Mailing Address
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Address Line | 4891 MILLER TRUNK HWY STE 206
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City | HERMANTOWN
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State | MN
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Zip | 55811-1563
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Country | US
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Telephone | 218-306-8383
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Fax | 218-875-6315
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 9509
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License Number State | MN
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