Provider Demographics
NPI:1528654175
Name:RENDINA, HEIDI LOVE (NBCHWC)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:LOVE
Last Name:RENDINA
Suffix:
Gender:F
Credentials:NBCHWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 BUFFALO SQUARE CT
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2785
Mailing Address - Country:US
Mailing Address - Phone:406-261-2534
Mailing Address - Fax:
Practice Address - Street 1:102 BUFFALO SQUARE CT
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2785
Practice Address - Country:US
Practice Address - Phone:406-261-2534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-17
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT174H00000X
MTA-3256065171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator