Provider Demographics
NPI:1013308014
Name:HENRICKSEN, BRIAN (PARAMEDIC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:HENRICKSEN
Suffix:
Gender:M
Credentials:PARAMEDIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 OUTRIGGER CIR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-5440
Mailing Address - Country:US
Mailing Address - Phone:925-550-1925
Mailing Address - Fax:
Practice Address - Street 1:2741 NAPA VALLEY CORPORATE DR
Practice Address - Street 2:BUILDING #2
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6216
Practice Address - Country:US
Practice Address - Phone:925-550-1925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAP19553146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic