Healthcare Provider Details

I. General information

NPI: 1467877282
Provider Name (Legal Business Name): STEVEN HENRIE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2014
Last Update Date: 03/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5163 MARGO DR
LAS VEGAS NV
89122-6627
US

IV. Provider business mailing address

5163 MARGO DR
LAS VEGAS NV
89122-6627
US

V. Phone/Fax

Practice location:
  • Phone: 702-372-0976
  • Fax:
Mailing address:
  • Phone: 702-372-0976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: