Provider Demographics
NPI:1578858957
Name:HENWOOD, STEVE WESLEY (RN)
Entity Type:Individual
Prefix:MR
First Name:STEVE
Middle Name:WESLEY
Last Name:HENWOOD
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2252 SE SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-5362
Mailing Address - Country:US
Mailing Address - Phone:503-233-3968
Mailing Address - Fax:
Practice Address - Street 1:2252 SE SPRUCE AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-5362
Practice Address - Country:US
Practice Address - Phone:503-233-3968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200540917RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse