Provider Demographics
NPI:1396854071
Name:HENDRICKSON, DEBRA J (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:J
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:75 PRINGLE WAY
Mailing Address - Street 2:301
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1464
Mailing Address - Country:US
Mailing Address - Phone:775-686-4300
Mailing Address - Fax:775-686-4322
Practice Address - Street 1:75 PRINGLE WAY
Practice Address - Street 2:301
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1464
Practice Address - Country:US
Practice Address - Phone:775-686-4300
Practice Address - Fax:775-686-4322
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2020-07-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA93610208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics