Individual
MR. JACK ERNEST HENDRICKSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
1060 GAFFNEY RD, COMMANDER, USA-MEDDAC-AK, ATTN; MCUC-MMD-QM, FT WAINWRIGHT, AK 99703-5001
(907) 353-1207
Mailing address
2005 JACK ST, FAIRBANKS, AK 99709-4113
(907) 451-9414
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4735
AK
Other
Enumeration date
02/02/2006
Last updated
07/08/2007
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