Provider Demographics
NPI:1730626730
Name:HENRY, STEPHANIE ANN (ICCE)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ANN
Last Name:HENRY
Suffix:
Gender:F
Credentials:ICCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399990 W 3700 RD
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:OK
Mailing Address - Zip Code:74061-2540
Mailing Address - Country:US
Mailing Address - Phone:918-766-3882
Mailing Address - Fax:
Practice Address - Street 1:399990 W 3700 RD
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:OK
Practice Address - Zip Code:74061-2540
Practice Address - Country:US
Practice Address - Phone:918-766-3882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator