Amber Rose Hendriksen, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

9490 Issued in WI

Practice address

1507 Doctors CT
Watertown, WI 53094-4101

Phone

(920) 261-4111

NPI assigned

Sep 17, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Amber Rose Werth Former name

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prohealth Medical Group IncGroup PAC ID 3476465188, 475 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Prohealth Medical Group Inc.

  • Pediatrics Physician
  • Waukesha, WI
  • NPI 1356322440
  Medicare reassignment Care Compare group NPD
• Watertown Physician Practices LLC

  • Family Medicine Physician
  • Watertown, WI
  • NPI 1770964363
  Medicare reassignment NPD
• Watertown Physician Practices LLC

  dba Watertown Medical Clinic

  • Family Medicine Physician
  • Watertown, WI
  • NPI 1003383027
  NPD
• Watertown Physician Practices LLC

  • Obstetrics & Gynecology Physician
  • Watertown, WI
  • NPI 1225412265

  Nurse Practitioner

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1568678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677801600000",
    "number": "1881244358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 HOSPITAL DR",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530983303",
            "telephone_number": "920-262-4495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1507 DOCTORS CT",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530944101",
            "telephone_number": "920-261-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDRIKSEN",
        "first_name": "AMBER",
        "middle_name": "ROSE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-17",
        "last_updated": "2023-03-03",
        "certification_date": "2023-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "9490",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "9490",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMBER",
            "last_name": "WERTH",
            "middle_name": "ROSE",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Gary C Hauser, MD
• Healthstat Onsite Clinic Watertown
• Hearing Center, Inc.
• Melanie Terese Heese, RN
• Robert Delano Heinen, MD
• Heritage Assisted Living of Watertown, LLC (Heritage Homes Assisted Living)
• Shandell Lee Herrick, FNP-BC
• Desiree Monik Herron, O.D.
• Gwen Herzog, RN
• Catherine Hetzel

• Family Nurse Practitioner in Watertown, WI
• Providers in Watertown, WI by specialty
• Family Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.