Individual
MISS AUDREY LYN HENDRICKS-ELLISTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3511 BARNES AVE, TILDEN TOWERS 1 APT 6G, BRONX, NY 10467-6031
(718) 519-0515
(718) 519-0515
Mailing address
PO BOX 1103, BRONX, NY 10466-0563
(718) 519-0515
(718) 519-0515
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
296537-1
NY
164W00000X
Licensed Practical Nurse
2965371
NY
Other
Enumeration date
03/02/2016
Last updated
03/02/2016
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