Provider Demographics
NPI:1356009047
Name:HENNING, STEPHANIE LOZADA (NP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LOZADA
Last Name:HENNING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 WEST AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-1229
Mailing Address - Country:US
Mailing Address - Phone:585-758-7557
Mailing Address - Fax:585-637-5626
Practice Address - Street 1:156 WEST AVE FL 2
Practice Address - Street 2:
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-1229
Practice Address - Country:US
Practice Address - Phone:585-758-7557
Practice Address - Fax:585-637-5626
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY348501363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily