Provider Demographics
NPI:1811018807
Name:HENRY, CHARLOTTE LETITIA (DRPH, RD, CDE)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:LETITIA
Last Name:HENRY
Suffix:
Gender:F
Credentials:DRPH, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5337
Mailing Address - Street 2:
Mailing Address - City:ST CROIX
Mailing Address - State:VI
Mailing Address - Zip Code:00823-5337
Mailing Address - Country:US
Mailing Address - Phone:340-719-2770
Mailing Address - Fax:340-719-8338
Practice Address - Street 1:4500 SUNNY ISLE
Practice Address - Street 2:SUITE 1B
Practice Address - City:ST CROIX
Practice Address - State:VI
Practice Address - Zip Code:00820-4493
Practice Address - Country:US
Practice Address - Phone:340-719-2770
Practice Address - Fax:340-719-8338
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI005-7117Medicare ID - Type Unspecified