Provider Demographics
NPI:1770797151
Name:HENDRICKSON, MARISSA ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:ANNE
Last Name:HENDRICKSON
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Gender:F
Credentials:MD
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Mailing Address - Street 1:401 E RIVER PKWY
Mailing Address - Street 2:PEDIATRIC EMERGENCY MEDICINE, 76 VCRC
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0368
Mailing Address - Country:US
Mailing Address - Phone:612-625-6678
Mailing Address - Fax:612-626-1144
Practice Address - Street 1:401 E RIVER PKWY
Practice Address - Street 2:PEDIATRIC EMERGENCY MEDICINE, 76 VCRC
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0368
Practice Address - Country:US
Practice Address - Phone:612-625-6678
Practice Address - Fax:612-626-1144
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2008-08-13
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Provider Licenses
StateLicense IDTaxonomies
MN508512080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine