Provider Demographics
NPI:1871346882
Name:HENDRICKSEN, KRISTINA (MSN, RN, SNSC)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:HENDRICKSEN
Suffix:
Gender:F
Credentials:MSN, RN, SNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 W LUGONIA AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2233
Mailing Address - Country:US
Mailing Address - Phone:909-602-2177
Mailing Address - Fax:
Practice Address - Street 1:33 W LUGONIA AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2233
Practice Address - Country:US
Practice Address - Phone:909-602-2177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA783631163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse