Provider Demographics
NPI:1922537554
Name:HENDRICKSON, ELIZABETH M (PA-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:M
Other - Last Name:MATULKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:575 S 70TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2471
Mailing Address - Country:US
Mailing Address - Phone:402-484-4030
Mailing Address - Fax:402-488-1172
Practice Address - Street 1:575 S 70TH ST STE 200
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2471
Practice Address - Country:US
Practice Address - Phone:402-484-4030
Practice Address - Fax:402-488-1172
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2139363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant