Provider Demographics
NPI:1508093956
Name:HENDRICKS, ARLENE (LPN)
Entity Type:Individual
Prefix:
First Name:ARLENE
Middle Name:
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 MAIN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:CATSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12414-1366
Mailing Address - Country:US
Mailing Address - Phone:518-719-3600
Mailing Address - Fax:518-719-3783
Practice Address - Street 1:411 MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-1366
Practice Address - Country:US
Practice Address - Phone:518-719-3600
Practice Address - Fax:518-719-3783
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148294-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
004394OtherEMPIRE BC
NY10002875OtherCDPHP
NY000400508001OtherBLUE SHIELD NE NY
NY00473230Medicaid
NY337050OtherMEDICARE A