Provider Demographics
NPI:1427661834
Name:HENDRICKSON, NATALIE (A-GNP)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:A-GNP
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:
Other - Last Name:PORTIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:285 PEMBERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-7780
Mailing Address - Country:US
Mailing Address - Phone:251-895-7380
Mailing Address - Fax:
Practice Address - Street 1:425 BARONY ST
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3128
Practice Address - Country:US
Practice Address - Phone:843-899-7399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24401363L00000X, 363LA2200X
SC245450163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered Nurse