Provider Demographics
NPI:1649608746
Name:HOVENDICK, MEAGAN G (RD)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:G
Last Name:HOVENDICK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 BEAL ST
Mailing Address - Street 2:
Mailing Address - City:OGALLALA
Mailing Address - State:NE
Mailing Address - Zip Code:69153-1537
Mailing Address - Country:US
Mailing Address - Phone:402-430-8739
Mailing Address - Fax:
Practice Address - Street 1:1220 BEAL ST
Practice Address - Street 2:
Practice Address - City:OGALLALA
Practice Address - State:NE
Practice Address - Zip Code:69153-1537
Practice Address - Country:US
Practice Address - Phone:402-430-8739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1050133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered