Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | R-10362 | IA |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 11741886-1205 | UT |
NPI | 1306227632 |
---|---|
Provider Name | Nathan R. Hendrickson |
First Address | Salt Lake City, UT 84108-1200 |
Second Address | Salt Lake City, UT 84108-1200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2015 |
Last Update Date | 05/06/2020 |