Healthcare Provider Details

I. General information

NPI: 1881207199
Provider Name (Legal Business Name): STEVEN BRADLEY HENKELS NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 08/26/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 ROEDER CIR
FORT SNELLING MN
55111-4017
US

IV. Provider business mailing address

506 ROEDER CIR
FORT SNELLING MN
55111-4017
US

V. Phone/Fax

Practice location:
  • Phone: 612-713-3953
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5902
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: