Provider Demographics
NPI:1316668544
Name:STEPHANIE HENDRICKS, PLLC
Entity type:Organization
Organization Name:STEPHANIE HENDRICKS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-C
Authorized Official - Phone:701-652-5109
Mailing Address - Street 1:708 RIVERBEND RD
Mailing Address - Street 2:
Mailing Address - City:OXBOW
Mailing Address - State:ND
Mailing Address - Zip Code:58047-5015
Mailing Address - Country:US
Mailing Address - Phone:701-652-5109
Mailing Address - Fax:
Practice Address - Street 1:3989 4TH ST E STE 2
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-2865
Practice Address - Country:US
Practice Address - Phone:701-652-5109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty