Active NPI
Andrea Elizabeth Hendricks, PAC
- Medical Physician Assistant
- Duluth, MN
National Provider Identifier
1376570283
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 9308
- Practice address
- 615 Niagara CT
Umd Health Services
Duluth, MN 55812-3065 - Phone
- (218) 726-8155
- Fax
- (218) 726-6132
- NPI assigned
- Jun 27, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 9308 | MN | Primary |
Addresses
Primary practice location
615 Niagara CT
Umd Health Services
Duluth, MN 55812-3065
Mailing address
5290 Lakewood Road
Duluth, MN 55804
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9308 | MN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1376570283",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5290 LAKEWOOD ROAD",
"city": "DULUTH",
"state": "MN",
"postal_code": "55804"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "615 NIAGARA CT",
"address_2": "UMD HEALTH SERVICES",
"city": "DULUTH",
"state": "MN",
"postal_code": "558123065",
"telephone_number": "218-726-8155",
"fax_number": "218-726-6132"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDRICKS",
"first_name": "ANDREA",
"middle_name": "ELIZABETH",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "MN",
"license": "9308",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Duluth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.