Provider Demographics
NPI:1699205757
Name:HENDRICKS, LAUREN (DNP, NP-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:DNP, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 E THOMAS RD STE 230
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-3100
Mailing Address - Country:US
Mailing Address - Phone:602-557-0007
Mailing Address - Fax:
Practice Address - Street 1:10301 N 92ND ST STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4506
Practice Address - Country:US
Practice Address - Phone:480-661-2662
Practice Address - Fax:480-661-9716
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10230363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ275812Medicaid