Provider Demographics
NPI:1306602123
Name:HENDRICK, ELLEN MAKENZIE
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:MAKENZIE
Last Name:HENDRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25090 WOODWARD AVE APT 209
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-0984
Mailing Address - Country:US
Mailing Address - Phone:989-751-3514
Mailing Address - Fax:
Practice Address - Street 1:25090 WOODWARD AVE APT 209
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-0984
Practice Address - Country:US
Practice Address - Phone:989-751-3514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704308343163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine