Provider Demographics
NPI:1588252381
Name:HENDRICKS, MELISSA (RN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1385 S MOCCASIN TRL
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-7371
Mailing Address - Country:US
Mailing Address - Phone:602-463-4818
Mailing Address - Fax:
Practice Address - Street 1:525 W BROWN RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-3202
Practice Address - Country:US
Practice Address - Phone:480-684-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN211236163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine