Provider Demographics
NPI:1952897332
Name:HENRY, JENNIFER HENRY (ND)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:HENRY
Last Name:HENRY
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:HENRY
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ND
Mailing Address - Street 1:301 ALTA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-1942
Mailing Address - Country:US
Mailing Address - Phone:510-847-8055
Mailing Address - Fax:
Practice Address - Street 1:2041 BANCROFT WAY #303
Practice Address - Street 2:2041 BANCROFT WAY
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704
Practice Address - Country:US
Practice Address - Phone:510-847-8055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND973175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath