Healthcare Provider Details

I. General information

NPI: 1285161570
Provider Name (Legal Business Name): STEPHANIE HENIGIN RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 05/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3629 S D ST # MS 1100
TACOMA WA
98418-6813
US

IV. Provider business mailing address

3629 S D ST # MS 1100
TACOMA WA
98418-6813
US

V. Phone/Fax

Practice location:
  • Phone: 253-255-8384
  • Fax: 253-798-3522
Mailing address:
  • Phone: 253-255-8384
  • Fax: 253-798-3522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN60700820
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: