Provider Demographics
NPI:1891360996
Name:HENRY, CHRISTINE ST THERESA (PRACTICAL NURSE)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ST THERESA
Last Name:HENRY
Suffix:
Gender:F
Credentials:PRACTICAL NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 DYER ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-1333
Mailing Address - Country:US
Mailing Address - Phone:203-887-0258
Mailing Address - Fax:
Practice Address - Street 1:303 DYER ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-1333
Practice Address - Country:US
Practice Address - Phone:203-887-0258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000185376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1659018174OtherHOMEMAKER/COMPANION