Provider Demographics
NPI:1487892964
Name:HENDRICKSON, EMILY ELIZABETH (CPNP)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ELIZABETH
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ELIZABETH
Other - Last Name:BALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9000 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1180
Mailing Address - Country:US
Mailing Address - Phone:937-832-7337
Mailing Address - Fax:937-832-4817
Practice Address - Street 1:3140 DAYTON XENIA ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434
Practice Address - Country:US
Practice Address - Phone:937-320-1950
Practice Address - Fax:937-320-9332
Is Sole Proprietor?:No
Enumeration Date:2009-01-22
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-10256363LP0200X
OHAPRN.CNP.10256363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0326400Medicaid