Provider Demographics
NPI:1558646901
Name:HENDRICKSON, SANDRA T
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:T
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-3525
Mailing Address - Country:US
Mailing Address - Phone:912-287-4863
Mailing Address - Fax:912-287-5875
Practice Address - Street 1:604 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-5323
Practice Address - Country:US
Practice Address - Phone:912-287-4863
Practice Address - Fax:912-287-5875
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN080911363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health