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Individual

MR. STEPHEN A HENEFIELD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
C.R.N.A.

Contact information

Practice address
1171 W TARGET RANGE RD, NOGALES, AZ 85621-2415
(520) 285-8010
Mailing address
2202 N FORBES BLVD, TUCSON, AZ 85745-1412
(520) 872-7536
(520) 872-7929

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
R 075850-1
MN
367500000X
Certified Registered Nurse Anesthetist
Primary
RN138245
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
101828
AZ
05
702243300
MN
01
Z144889
MEDICARE PTAN
AZ
Enumeration date
01/10/2006
Last updated
01/11/2012
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