Provider Demographics
NPI:1184432742
Name:HENDRICKS, LANCE
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:HENDRICKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 NE 109TH CT STE A
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6104
Mailing Address - Country:US
Mailing Address - Phone:360-727-1641
Mailing Address - Fax:877-349-1934
Practice Address - Street 1:5500 NE 109TH CT STE A
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6104
Practice Address - Country:US
Practice Address - Phone:360-727-1641
Practice Address - Fax:877-349-1934
Is Sole Proprietor?:No
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy