Provider Demographics
NPI:1447828751
Name:HENDRICKSON, MARINA
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:HENDRICKSON
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 1:2701 CONNECTICUT AVE NW APT 402
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-5301
Mailing Address - Country:US
Mailing Address - Phone:719-360-5710
Mailing Address - Fax:
Practice Address - Street 1:1860 TOWN CENTER DR STE 270
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5899
Practice Address - Country:US
Practice Address - Phone:703-318-8157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant