Provider Demographics
NPI:1407092331
Name:HENDRICKS, LESLIE ANN (REGISTERED NURSE)
Entity Type:Individual
Prefix:MISS
First Name:LESLIE
Middle Name:ANN
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 E 59TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-5438
Mailing Address - Country:US
Mailing Address - Phone:347-432-1211
Mailing Address - Fax:
Practice Address - Street 1:239 E 59TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-5438
Practice Address - Country:US
Practice Address - Phone:347-627-3664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY526298-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse