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Contact Information

MICCA D HENRY, RDN
8495 CRATER LAKE HWY
MAIL STOP: 120
WHITE CITY, OR97503
 Phone: 541-826-2111
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dietitian, Registered

133V00000X 71 Registered Dietitian or Nutrition Professional
Indicates primary specialty

NPI Profile & details for MICCA D HENRY · (Male)

NPI # 1649047952
Status Active
Credentials RDN
Entity Individual
Enumeration date 12/06/2023
Last updated 12/06/2023 - About 2 years ago
Sole proprietor 1 No
Identifiers Not Available
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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