Provider Demographics
NPI:1407190309
Name:HENDRICKS, EDWARD MACK (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:MACK
Last Name:HENDRICKS
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1181 PADDOCK RD
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-9679
Mailing Address - Country:US
Mailing Address - Phone:302-653-9261
Mailing Address - Fax:302-659-6887
Practice Address - Street 1:1181 PADDOCK RD
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-9679
Practice Address - Country:US
Practice Address - Phone:302-653-9261
Practice Address - Fax:302-659-6887
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0000616363LF0000X
MDR159470363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily