Provider Demographics
NPI:1144579137
Name:FERRY, LENKA FENCLOVA (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:LENKA
Middle Name:FENCLOVA
Last Name:FERRY
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 SPRINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-9745
Mailing Address - Country:US
Mailing Address - Phone:609-504-0012
Mailing Address - Fax:
Practice Address - Street 1:4309 SPRINGWOOD DR
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-9745
Practice Address - Country:US
Practice Address - Phone:609-504-0012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLD0734133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered