Provider Demographics
NPI:1194151878
Name:HENDRIKS, SCOTT KEEN (RN)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:KEEN
Last Name:HENDRIKS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 MEADE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-5058
Mailing Address - Country:US
Mailing Address - Phone:720-215-0750
Mailing Address - Fax:
Practice Address - Street 1:2108 MEADE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-5058
Practice Address - Country:US
Practice Address - Phone:720-215-0750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO162666282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO162666OtherRN