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NPI Code Detail

MEDICARE: MRS. ROSETTA T HENDRICKS RN, CFNP

MEDICARE: MRS. ROSETTA T HENDRICKS RN, CFNP
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
1363LF0000XFamily Nurse PractitionerRN39420DC
2363LF0000XFamily Nurse PractitionerR118050MD

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00144321OTHERDCRR MEDICARE

General Provider Information

NPI Number : 1851327217
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ROSETTA T HENDRICKS RN, CFNP
Provider Business Mailing Address
First Line : 3116 FESSENDEN ST NW
Second Line :
City : WASHINGTON
State : DC
Zip : 20008-2029
Country : US
Telephone Number : 301-942-0678
Fax Number : 301-942-0079
Provider Business Practice Location Address
First Line : 3937 FERRARA DR
Second Line :
City : SILVER SPRING
State : MD
Zip : 20906-4709
Country : US
Telephone Number : 301-942-0678
Fax Number : 301-942-0079
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2006
Last Update Date : 09/07/2011

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