Provider Demographics
NPI:1962063453
Name:HENKER, CRAIG J
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:J
Last Name:HENKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 TEEGARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-4541
Mailing Address - Country:US
Mailing Address - Phone:530-674-4530
Mailing Address - Fax:530-674-4544
Practice Address - Street 1:2 9TH ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-5362
Practice Address - Country:US
Practice Address - Phone:530-742-6670
Practice Address - Fax:530-742-2793
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist