Provider Demographics
NPI:1558490979
Name:NOUWEN, HENDRIKA MARIA (RN, CMT)
Entity Type:Individual
Prefix:
First Name:HENDRIKA
Middle Name:MARIA
Last Name:NOUWEN
Suffix:
Gender:F
Credentials:RN, CMT
Other - Prefix:
Other - First Name:HENNY
Other - Middle Name:MARIA
Other - Last Name:NOUWEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, CMT
Mailing Address - Street 1:11990 SHENANDOAH RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CA
Mailing Address - Zip Code:95461-7708
Mailing Address - Country:US
Mailing Address - Phone:707-772-7298
Mailing Address - Fax:
Practice Address - Street 1:11990 SHENANDOAH RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CA
Practice Address - Zip Code:95461-7708
Practice Address - Country:US
Practice Address - Phone:707-772-7298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00005693174400000X
CA211536163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WANO 0704OtherREGENCE PROVIDER ID
WA78574OtherPROVIDER ID L & I
WA350041001OtherGROUP HEALTH PROVIDER ID