Provider Demographics
NPI:1972169548
Name:HENRICKSEN, DORA (RN)
Entity Type:Individual
Prefix:
First Name:DORA
Middle Name:
Last Name:HENRICKSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DORA
Other - Middle Name:
Other - Last Name:PYKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6107 S HAZEL ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98178-2452
Mailing Address - Country:US
Mailing Address - Phone:206-331-6063
Mailing Address - Fax:
Practice Address - Street 1:325 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2420
Practice Address - Country:US
Practice Address - Phone:206-744-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-19
Last Update Date:2019-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60027163163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse