Provider Demographics
NPI:1366986069
Name:HENDRICKS, SYDNEY (NP)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15179 FOX RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-0206
Mailing Address - Country:US
Mailing Address - Phone:909-996-7621
Mailing Address - Fax:951-587-8277
Practice Address - Street 1:10300 W CHARLESTON BLVD STE 17R16
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-1037
Practice Address - Country:US
Practice Address - Phone:725-305-2819
Practice Address - Fax:725-325-8300
Is Sole Proprietor?:No
Enumeration Date:2016-12-14
Last Update Date:2024-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV866836363L00000X
CA95005373363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner