Provider Demographics
NPI:1003184607
Name:KENDRICK, DWAN RENEE (RN)
Entity Type:Individual
Prefix:MRS
First Name:DWAN
Middle Name:RENEE
Last Name:KENDRICK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 290
Mailing Address - Street 2:
Mailing Address - City:WANBLEE
Mailing Address - State:SD
Mailing Address - Zip Code:57577-0290
Mailing Address - Country:US
Mailing Address - Phone:605-462-6155
Mailing Address - Fax:
Practice Address - Street 1:210 FIRST STREET
Practice Address - Street 2:
Practice Address - City:WANBLEE
Practice Address - State:SD
Practice Address - Zip Code:57577
Practice Address - Country:US
Practice Address - Phone:605-462-6155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR035704163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse