Provider Demographics
NPI:1205833415
Name:HAGENHOFF, SHERRIE FRANCES (RD, LD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:SHERRIE
Middle Name:FRANCES
Last Name:HAGENHOFF
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:MS
Other - First Name:SHERRIE
Other - Middle Name:FRANCES
Other - Last Name:DEFFENBAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LD, CDE
Mailing Address - Street 1:5619 N FARM ROAD 125
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-6209
Mailing Address - Country:US
Mailing Address - Phone:417-300-9679
Mailing Address - Fax:
Practice Address - Street 1:5619 N FARM ROAD 125
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-6209
Practice Address - Country:US
Practice Address - Phone:417-300-9679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001008947133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO81528Medicare UPIN