Healthcare Provider Details

I. General information

NPI: 1558490979
Provider Name (Legal Business Name): HENDRIKA MARIA NOUWEN R.N., C.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HENNY MARIA NOUWEN R.N., C.M.T.

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 11/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11990 SHENANDOAH RD
MIDDLETOWN CA
95461-7708
US

IV. Provider business mailing address

11990 SHENANDOAH RD
MIDDLETOWN CA
95461-7708
US

V. Phone/Fax

Practice location:
  • Phone: 707-772-7298
  • Fax:
Mailing address:
  • Phone: 707-772-7298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00005693
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number211536
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: