Provider Demographics
NPI:1851327217
Name:HENDRICKS, ROSETTA T (RN, CFNP)
Entity Type:Individual
Prefix:MRS
First Name:ROSETTA
Middle Name:T
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:RN, CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3116 FESSENDEN ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-2029
Mailing Address - Country:US
Mailing Address - Phone:301-942-0678
Mailing Address - Fax:301-942-0079
Practice Address - Street 1:3937 FERRARA DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-4709
Practice Address - Country:US
Practice Address - Phone:301-942-0678
Practice Address - Fax:301-942-0079
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN39420363LF0000X
MDR118050363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCP00144321OtherRR MEDICARE
DCP00144321OtherRR MEDICARE
R80486Medicare UPIN
DC579635L66Medicare ID - Type UnspecifiedDC, MD, NO VIRGINIA
DC022716M72Medicare UPIN