Healthcare Provider Details

I. General information

NPI: 1801501911
Provider Name (Legal Business Name): STEVEN HENNING PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 W 9TH ST
WATERLOO IA
50702-5401
US

IV. Provider business mailing address

3421 W 9TH ST
WATERLOO IA
50702-5401
US

V. Phone/Fax

Practice location:
  • Phone: 319-272-8349
  • Fax: 319-272-8355
Mailing address:
  • Phone: 319-272-8349
  • Fax: 319-272-8355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number117941
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: