Provider Demographics
NPI:1780902247
Name:HENDRICK, PASCALE CANAL (FNP)
Entity type:Individual
Prefix:
First Name:PASCALE
Middle Name:CANAL
Last Name:HENDRICK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-3505
Mailing Address - Country:US
Mailing Address - Phone:516-285-4650
Mailing Address - Fax:
Practice Address - Street 1:59 BROWN ST
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-3505
Practice Address - Country:US
Practice Address - Phone:516-285-4650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-08
Last Update Date:2010-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336261363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily