Provider Demographics
NPI:1881242725
Name:HENDRICKSON, NICOLE (FPA FNP-BC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:FPA FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 HIGHVIEW ST
Mailing Address - Street 2:
Mailing Address - City:SPRING GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60081-9609
Mailing Address - Country:US
Mailing Address - Phone:815-900-7330
Mailing Address - Fax:928-268-0163
Practice Address - Street 1:2440 HIGHVIEW ST
Practice Address - Street 2:
Practice Address - City:SPRING GROVE
Practice Address - State:IL
Practice Address - Zip Code:60081-9609
Practice Address - Country:US
Practice Address - Phone:815-900-7330
Practice Address - Fax:928-268-0163
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277.001900363LF0000X
IL377.001830207Q00000X
IL209020152363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine