Provider Demographics
NPI:1235850991
Name:HENDRICKS, ANNE KATHERINE
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:KATHERINE
Last Name:HENDRICKS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4891 MILLER TRUNK HWY STE 206
Mailing Address - Street 2:
Mailing Address - City:HERMANTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55811-1563
Mailing Address - Country:US
Mailing Address - Phone:218-306-8383
Mailing Address - Fax:218-875-6315
Practice Address - Street 1:4891 MILLER TRUNK HWY
Practice Address - Street 2:
Practice Address - City:HERMANTOWN
Practice Address - State:MN
Practice Address - Zip Code:55811-1512
Practice Address - Country:US
Practice Address - Phone:218-306-8383
Practice Address - Fax:218-875-6315
Is Sole Proprietor?:No
Enumeration Date:2022-09-09
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9509363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health