Healthcare Provider Details

I. General information

NPI: 1205833415
Provider Name (Legal Business Name): SHERRIE FRANCES HAGENHOFF RD, LD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHERRIE FRANCES DEFFENBAUGH LD, CDE

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5619 N FARM ROAD 125
SPRINGFIELD MO
65803-6209
US

IV. Provider business mailing address

5619 N FARM ROAD 125
SPRINGFIELD MO
65803-6209
US

V. Phone/Fax

Practice location:
  • Phone: 417-300-9679
  • Fax:
Mailing address:
  • Phone: 417-300-9679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2001008947
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: