Provider Demographics
NPI:1982047148
Name:HENDRICKS, LAURA (DO)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 NE HOYT ST STE B55
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2957
Mailing Address - Country:US
Mailing Address - Phone:208-392-8037
Mailing Address - Fax:
Practice Address - Street 1:5050 NE HOYT ST STE B55
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2957
Practice Address - Country:US
Practice Address - Phone:503-233-5393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program