Provider Demographics
NPI:1881207199
Name:HENKELS, STEVEN BRADLEY (NP-C)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:BRADLEY
Last Name:HENKELS
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 ROEDER CIR
Mailing Address - Street 2:
Mailing Address - City:FORT SNELLING
Mailing Address - State:MN
Mailing Address - Zip Code:55111-4017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:506 ROEDER CIR
Practice Address - Street 2:
Practice Address - City:FORT SNELLING
Practice Address - State:MN
Practice Address - Zip Code:55111-4017
Practice Address - Country:US
Practice Address - Phone:612-713-3953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5902363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily