Provider Demographics
NPI:1760596035
Name:HENDRICKSON, VANESSA JO (NP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:JO
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:JO
Other - Last Name:MACINTYRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 661
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-1000
Mailing Address - Fax:585-276-1985
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX 661
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-1000
Practice Address - Fax:585-276-1985
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303053363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02677856Medicaid
NYJ400076836Medicare PIN