| Doctor Name: | DR. LYNN ANDRE HENRICKSON |
| NPI Number: | 1225013766 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | MD2005-0215 |
| Business Practice Address: | 17 La Aguapa Sandia Park, NM - 870479676 |
| Business Phone Number: | 5052868027 |
| Business Fax Number: | |
| Mailing Address: | 17 La Aguapa, SANDIA PARK |
| State: | NM |
| Postal Code: | 870479676 |
| Phone Number: | 5052868027 |
| Fax Number: | |
| NPI Enumeration Date: | 12/07/2005 |
| NPI Last Update Date: | 01/06/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085R0202X |
| License Number: | MD2005-0215 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Diagnostic Radiology |
| Taxonomy Definition: | A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |