Basic Information
| Provider Information | |||||||||
| NPI: | 1699205757 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HENDRICKS | ||||||||
| FirstName: | LAUREN | ||||||||
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| Credential: | DNP, NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 77 E THOMAS RD STE 230 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850123100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6025570007 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10301 N 92ND ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852584506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806612662 | ||||||||
| FaxNumber: | 4806619716 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2017 | ||||||||
| LastUpdateDate: | 01/15/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP10230 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 275812 | 05 | AZ | MEDICAID |