Provider Demographics
NPI:1891225934
Name:HENDRICKS, GWENDOLYN M
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:M
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1672 INDEPENDENCE DR STE 310
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-3982
Mailing Address - Country:US
Mailing Address - Phone:830-730-5025
Mailing Address - Fax:830-215-4695
Practice Address - Street 1:1770 STATE HIGHWAY 46 W STE 1201
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-5393
Practice Address - Country:US
Practice Address - Phone:830-730-4375
Practice Address - Fax:830-730-4203
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-12
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134123363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty