Provider Demographics
NPI:1871728246
Name:HENDERSON, STEPHANIE LEESON (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:LEESON
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:ANNE
Other - Last Name:LEESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50302-0424
Mailing Address - Country:US
Mailing Address - Phone:515-875-9255
Mailing Address - Fax:515-875-9223
Practice Address - Street 1:1215 PLEASANT ST
Practice Address - Street 2:STE 206
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309
Practice Address - Country:US
Practice Address - Phone:515-875-9092
Practice Address - Fax:515-875-9828
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-40078207R00000X
IA40078207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine