Provider Demographics
NPI:1861204984
Name:HENKEL, CHARLES DAVID
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:DAVID
Last Name:HENKEL
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 1:769 MARY JORDAN LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-7076
Mailing Address - Country:US
Mailing Address - Phone:910-489-2721
Mailing Address - Fax:
Practice Address - Street 1:769 MARY JORDAN LN
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-7076
Practice Address - Country:US
Practice Address - Phone:910-489-2721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC929191163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management