DR. MARY NICOLE HENDERSON (NPI# 1245578202) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245578202 |
| Entity Type | Individual |
| Full Name | DR. MARY NICOLE HENDERSON |
| Credential | PHD, RD |
| Practice Address |
747 52nd St Oakland CA 94609-1809 |
| Practice Telephone | 5104283885 |
| Practice Fax Number | 5104283284 |
| Enumeration Date | 2013-01-26 |
| Last Update Date | 2013-01-26 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 133V00000X | Dietitian, Registered | Dietary & Nutritional Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699326843 | Mary Ann Henderson | Technician | 339 Mason Blvd, Jackson, MS 39212-5151 | 2019-09-27 |
| 1801379599 | Mary Pullias Henderson | Nurse Practitioner | 2788 Murfreesboro Road, Antioch, TN 37013-2004 | 2018-09-10 |
| 1063935773 | Mary Kathryn Henderson | Speech-Language Pathologist | 1400 Griffin Mill Road, Easley, SC 29640 | 2017-07-25 |
| 1467832485 | Mary Ellen Henderson | Registered Nurse | 1038 Davis Rd, West Falls, NY 14170-9781 | 2015-06-04 |
| 1003305798 | Mary Henderson | Community Health Worker | 104 S Front Ave, Prestonsburg, KY 41653-1614 | 2018-05-08 |
| 1225547508 | Mary Kathleen Henderson | Counselor | 393 Main St, Danville, NH 03819-3219 | 2017-09-29 |
| 1285181776 | Mary May Henderson | Nurse Practitioner | 10701 W Research Dr, Wauwatosa, WI 53226-3452 | 2016-09-01 |
| 1538517149 | Mary Henderson | Case Manager/Care Coordinator | 25 Gap Rd, Batesville, AR 72501-8679 | 2016-05-25 |
| 1548616535 | Mary K Henderson | Social Worker | 4400 Euclid Ave, Cleveland, OH 44103-3734 | 2016-05-09 |
| 1013391762 | Mary Henderson | Nurse Practitioner | 447 Mcalister Rd, Ste 2400, Lincolnton, NC 28092-4114 | 2015-07-13 |
| Street Address |
747 52ND ST |
| City | OAKLAND |
| State | CA |
| Zip Code | 94609-1809 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942200928 | James Philip Riddel Jr. | Nurse Practitioner | 747 52nd St, Oakland, CA 94609-1809 | 2005-07-29 |
| 1235739905 | Maria Elena Alicia Valdivia Fortuna | Social Worker | 747 52nd St, Oakland, CA 94609-1809 | 2020-10-30 |
| 1295342707 | Jenny Chen | Dietitian, Registered | 747 52nd St, Oakland, CA 94609-1809 | 2020-09-29 |
| 1104433028 | Phuong T Nguyen-tran | Pharmacist | 747 52nd St, Oakland, CA 94609-1809 | 2020-09-24 |
| 1114538899 | Ji Yun Lee | Student in an Organized Health Care Education/Training Program | 747 52nd St, Oakland, CA 94609-1809 | 2020-08-14 |
| 1780295857 | Luis Alonso Perez Jr. | Social Worker | 747 52nd St, Oakland, CA 94609-1809 | 2020-08-12 |
| 1255941803 | Aleesia Renta-ramirez | Student in an Organized Health Care Education/Training Program | 747 52nd St, Oakland, CA 94609-1809 | 2020-08-07 |
| 1831709773 | Carroll Taylor Brown IIi | Registered Nurse | 747 52nd St, Oakland, CA 94609-1809 | 2020-08-05 |
| 1053921064 | Jessica Stankiewicz Lightcap | Registered Nurse | 747 52nd St, Oakland, CA 94609-1809 | 2020-08-04 |
| 1184242307 | Cecilia Fairley | Genetic Counselor, MS | 747 52nd St, Oakland, CA 94609-1809 | 2020-07-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104457159 | Gerard John-charles Coughlin | Student in an Organized Health Care Education/Training Program | Samuel Merritt University, 3100 Telegraph Avenue, Oakland, CA 94609 | 2020-01-29 |
| 1417502022 | Michael Knittel | Registered Nurse | 370 Hawthorne Ave, Oakland, CA 94609 | 2019-08-09 |
| 1962057562 | Nicole Kjolby | Registered Nurse | Samuel Merritt College, 370 Hawthorne Ave, Oakland, CA 94609 | 2019-08-09 |
| 1396208286 | Graham Vallis | Student in an Organized Health Care Education/Training Program | Ucsf Benioff Children's Hospital Oakland, 747 52nd Street, Oakland, CA 94609 | 2019-04-09 |
| 1386129526 | Gary Mitchell Snider | Counselor | 390 40th Street, Oakland, CA 94609 | 2018-10-02 |
| 1720568389 | Lice Control Inc. | Technician | 6557 Shattuck Ave, Oakland, CA 94609 | 2018-08-14 |
| 1528559150 | Jenna Marie Kincaid | Behavior Technician | 400 29th St., 204, Oakland, CA 94609 | 2018-05-18 |
| 1336656669 | Nicholas Dicarlo | Social Worker | 465 34th St Ste 6, Oakland, CA 94609 | 2018-01-09 |
| 1174045744 | Theodora J Marzouk | Home Health Aide | 3317 Elm Street, Suite 202, Oakland, CA 94609 | 2017-07-14 |
| 1740728922 | Elena Gardella | Marriage & Family Therapist | 411 30th Street, Suite 412, Oakland, CA 94609 | 2017-02-07 |
| Find all providers in zip 94609 | ||||
| Taxonomy Code | 133V00000X |
| Grouping | Dietary & Nutritional Service Providers |
| Classification | Dietitian, Registered |
| A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor’s degree at a US regionally accredited university or college and course work approved by The American Dietetic Association (ADA); an ADA-accredited or approved, supervised practice program, typically 6 to 12 months in length; a national examination administered by the Commission on Dietetic Registration; and continuing professional educational requirements to maintain registration. |
| Notes: Source: The American Dietetic Association. Becoming a Registered Dietitian – a food and nutrition expert. Chicago, IL: The American Dietetic Association, July 1997. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932712098 | Tiffany Xu | Dietitian, Registered | 600 William St Apt 416, Oakland, CA 94612-5411 | 2020-08-28 |
| 1184255903 | Susan Leung | Dietitian, Registered | 3012 Summit St Ste 2615, Oakland, CA 94609-3480 | 2020-01-30 |
| 1861031817 | Kate Alexa Schlag | Dietitian, Registered | 5867 Ocean View Dr, Oakland, CA 94618-1534 | 2019-12-21 |
| 1598307001 | Rebecca Thieneman | Dietitian, Registered | 663 43rd St, Oakland, CA 94609-1839 | 2019-10-16 |
| 1649825019 | Marianna Tong | Dietitian, Registered | 3600 Broadway # G, Oakland, CA 94611-5730 | 2019-08-02 |
| 1285133041 | Ruth Chisholm | Dietitian, Registered | 251 North Fourth Street, Oakland, MD 21550 | 2018-02-07 |
| 1285148825 | Cami Mandell Gorden | Dietitian, Registered | 2835 Helen St, Oakland, CA 94608-4025 | 2017-11-17 |
| 1063950673 | Jamie Foley | Dietitian, Registered | 2715 Ivy Dr, Oakland, CA 94606-2137 | 2017-02-02 |
| 1922460294 | Lindsay Marie Orbeta | Dietitian, Registered | 330 13th St, Suite 304, Oakland, CA 94612-3954 | 2016-03-24 |
| 1922466507 | Jaylene Tang | Dietitian, Registered | 3275 Hyde St, Oakland, CA 94601-2610 | 2016-02-10 |
| Find all providers in OAKLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.