Provider Demographics
NPI:1992149488
Name:HENDRICKS, JANE
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4849 E CORONADO RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-4215
Mailing Address - Country:US
Mailing Address - Phone:480-332-6667
Mailing Address - Fax:602-266-0340
Practice Address - Street 1:2909 N CENTRAL AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2741
Practice Address - Country:US
Practice Address - Phone:602-266-2010
Practice Address - Fax:602-266-0340
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ 03-714175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath