Provider Demographics
NPI:1871255885
Name:HENDRICK, HEATHER LYN (RN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYN
Last Name:HENDRICK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LYN
Other - Last Name:CHEESEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1538 SE SANFORD AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-4262
Mailing Address - Country:US
Mailing Address - Phone:541-680-4833
Mailing Address - Fax:
Practice Address - Street 1:1538 SE SANFORD AVE
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-4262
Practice Address - Country:US
Practice Address - Phone:541-680-4833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201243230RN163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health