Provider Demographics
NPI:1699773556
Name:HENDRIX, MARY L (RN-C, WHCNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:RN-C, WHCNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:LOUISE
Other - Last Name:HENDRIX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 110429
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-0429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:303-745-6925
Practice Address - Street 1:1635 AURORA CT
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2541
Practice Address - Country:US
Practice Address - Phone:720-848-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO47375363LW0102X
COAPN.0001502-NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO42954223Medicaid
COP40549Medicare UPIN
CO42954223Medicaid