Provider Demographics
NPI:1487345708
Name:BINGHAM, HENRY STEPHEN
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:STEPHEN
Last Name:BINGHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 MICHELANGELO CT
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-9211
Mailing Address - Country:US
Mailing Address - Phone:775-745-6419
Mailing Address - Fax:
Practice Address - Street 1:1260 NEVADA PACIFIC BLVD
Practice Address - Street 2:
Practice Address - City:FERNLEY
Practice Address - State:NV
Practice Address - Zip Code:89408-9871
Practice Address - Country:US
Practice Address - Phone:775-575-7171
Practice Address - Fax:775-575-7227
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant