Provider Demographics
NPI:1659967032
Name:HENDRIKS, ANGELA FRANCIS (LPN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:FRANCIS
Last Name:HENDRIKS
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 1:5293 JONES RESERVE WALK
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-9209
Mailing Address - Country:US
Mailing Address - Phone:770-256-7529
Mailing Address - Fax:
Practice Address - Street 1:5293 JONES RESERVE WALK
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-9209
Practice Address - Country:US
Practice Address - Phone:770-256-7529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN092786164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA20160318OtherLA STATE BOARD OF PRACTICAL NURSING
GALPN092786OtherSTATE OF GA BOARD OF PRACTICAL NURSING