Provider Demographics
NPI:1679206197
Name:HENDRICKSON, BRITTANY ANN (RDN/CD/DIETITIAN)
Entity Type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:ANN
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:RDN/CD/DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10909 56TH AVENUE CT E APT N104
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-5757
Mailing Address - Country:US
Mailing Address - Phone:580-291-1056
Mailing Address - Fax:
Practice Address - Street 1:10210 123RD STREET CT E STE D
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-2634
Practice Address - Country:US
Practice Address - Phone:580-291-1056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61308081133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered