Provider Demographics
NPI:1962433474
Name:HENRY, CHRISTINE NATALIE RENEE (CRNP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:NATALIE RENEE
Last Name:HENRY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:NATALIE RENEE
Other - Last Name:PILLINER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:10800 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-3043
Mailing Address - Country:US
Mailing Address - Phone:951-353-2000
Mailing Address - Fax:
Practice Address - Street 1:25333 BARTON RD
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3123
Practice Address - Country:US
Practice Address - Phone:909-558-6641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP15809363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05621ZMedicare PIN