Provider Demographics
NPI:1770083412
Name:HENIGAN, CHRISTINE (RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:
Last Name:HENIGAN
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:WILKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, LDN
Mailing Address - Street 1:104 W GORGAS LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2507
Mailing Address - Country:US
Mailing Address - Phone:631-513-2969
Mailing Address - Fax:
Practice Address - Street 1:104 W GORGAS LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-2507
Practice Address - Country:US
Practice Address - Phone:631-513-2969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1003705133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered