MEDICARE: CHRISTINA MARIE HENDRICKSON APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	17203-33	WI
2	363L00000X	Nurse Practitioner	209032976	IL
3	363L00000X	Nurse Practitioner	17203	WI
4	363LF0000X	Family Nurse Practitioner	209032976	IL

General Provider Information

NPI Number	:	1023993565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA MARIE HENDRICKSON APRN

Provider Business Mailing Address
First Line	:	515 22ND AVE
Second Line	:
City	:	MONROE
State	:	WI
Zip	:	53566-1569
Country	:	US
Telephone Number	:	608-250-0635
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 W 8TH ST
Second Line	:
City	:	MONROE
State	:	WI
Zip	:	53566-1021
Country	:	US
Telephone Number	:	83-241-9406
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2025
Last Update Date	:	08/29/2025

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