Provider Demographics
NPI:1417499831
Name:HEDRICK, VICTORIA (RDN, CDN)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:HEDRICK
Suffix:
Gender:F
Credentials:RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 MAGNOLIA BLVD
Mailing Address - Street 2:
Mailing Address - City:JOINT BASE LEWIS MCCHORD
Mailing Address - State:WA
Mailing Address - Zip Code:98433-1223
Mailing Address - Country:US
Mailing Address - Phone:865-368-0525
Mailing Address - Fax:
Practice Address - Street 1:6565 MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:JOINT BASE LEWIS MCCHORD
Practice Address - State:WA
Practice Address - Zip Code:98433-1223
Practice Address - Country:US
Practice Address - Phone:865-368-0525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA86050724133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered