Provider Demographics
NPI:1891898458
Name:HENDRIKSON, CAROLYN (ARNP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:HENDRIKSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 N JEFFERSON LN STE 200
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-7104
Mailing Address - Country:US
Mailing Address - Phone:509-625-3700
Mailing Address - Fax:509-625-3747
Practice Address - Street 1:546 N JEFFERSON LN STE 200
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-7104
Practice Address - Country:US
Practice Address - Phone:509-625-3700
Practice Address - Fax:509-625-3747
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004760363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
911019392OtherCOMMERCIAL
WA8933311OtherCRIME VICTIMS
WA165120OtherL & I
WA1021668Medicaid
WA165120OtherL & I
WA8933311OtherCRIME VICTIMS
WA9623042Medicaid
WA9623042Medicaid