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General NPI Number Information
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NPI Number | 1245239151
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Entity Type | Individual
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Provider Name | MARYANNE ELIZABETH HENDERSON R.D., LD/N
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Gender | Female
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Dates
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Enumeration Date | 07/21/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1520 FLETCHER ST
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City | HOLLYWOOD
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State | FL
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Zip | 33020-6511
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Country | US
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Telephone | 954-401-2946
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Fax |
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Provider Business Mailing Address
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Address Line | 1520 FLETCHER ST
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City | HOLLYWOOD
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State | FL
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Zip | 33020-6511
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Country | US
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Telephone | 954-923-6500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1005X
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Taxonomy Name | Renal Nutrition Registered Dietitian
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License Number | ND3567
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License Number State | FL
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