Provider Demographics
NPI:1699960211
Name:HENDRIX-MOUK, SALLYE A (DNM)
Entity type:Individual
Prefix:
First Name:SALLYE
Middle Name:A
Last Name:HENDRIX-MOUK
Suffix:
Gender:F
Credentials:DNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6509 GOVERNMENT ST
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-6238
Mailing Address - Country:US
Mailing Address - Phone:225-924-6533
Mailing Address - Fax:
Practice Address - Street 1:6509 GOVERNMENT ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6238
Practice Address - Country:US
Practice Address - Phone:225-924-6533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath