Provider Demographics
NPI:1790405017
Name:HENDRICKS, DEBI (RD, LD)
Entity Type:Individual
Prefix:
First Name:DEBI
Middle Name:
Last Name:HENDRICKS
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 1:505 SOOTHING MEADOWS DR NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-4089
Mailing Address - Country:US
Mailing Address - Phone:505-947-2222
Mailing Address - Fax:
Practice Address - Street 1:717 ENCINO PL NE STE 26
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2629
Practice Address - Country:US
Practice Address - Phone:505-884-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLD-1200133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered