Individual
JENNIE G HENDRIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
10004 204TH AVE E, SUITE 1300, BONNEY LAKE, WA 98391-6535
(253) 848-8797
(253) 826-1264
Mailing address
1706 MERIDIAN S, SUITE 120, PUYALLUP, WA 98371-7516
(253) 848-8797
(253) 446-3239
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD00036248
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8230062
DSHS NUMBER
WA
Enumeration date
01/02/2006
Last updated
11/14/2011
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