Provider Demographics
NPI:1932531753
Name:DEXTER-HINE, DEIDRA C (RD)
Entity type:Individual
Prefix:
First Name:DEIDRA
Middle Name:C
Last Name:DEXTER-HINE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:DEIDRA
Other - Middle Name:C
Other - Last Name:DEXTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1919 E THOMAS RD BLDG 2108
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7710
Mailing Address - Country:US
Mailing Address - Phone:602-512-8029
Mailing Address - Fax:602-512-8161
Practice Address - Street 1:5131 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2799
Practice Address - Country:US
Practice Address - Phone:480-833-5437
Practice Address - Fax:480-833-9349
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ970698133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered