Provider Demographics
NPI:1518928530
Name:HENDRICKS, JANIE C (DO)
Entity Type:Individual
Prefix:
First Name:JANIE
Middle Name:C
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50316-2339
Mailing Address - Country:US
Mailing Address - Phone:515-266-1000
Mailing Address - Fax:515-266-1824
Practice Address - Street 1:1201 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-2339
Practice Address - Country:US
Practice Address - Phone:515-266-1000
Practice Address - Fax:515-266-1824
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02794207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1518928530Medicaid
IA0122002Medicaid
IA110120090Medicare PIN
719260252Medicare PIN
IA51109Medicare PIN
IA1518928530Medicaid