Provider Demographics
NPI:1801229406
Name:ROOT, JOANNE HENDRICKS (RN)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:HENDRICKS
Last Name:ROOT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:JOANNE
Other - Middle Name:ELIZABETH
Other - Last Name:HENDRICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1030 FORT SUMTER DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-4308
Mailing Address - Country:US
Mailing Address - Phone:843-327-1420
Mailing Address - Fax:843-762-6212
Practice Address - Street 1:1825 CAMP RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-3504
Practice Address - Country:US
Practice Address - Phone:843-762-5533
Practice Address - Fax:843-762-6212
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRN51052163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool