Provider Demographics
NPI:1407801319
Name:HENDERSON, PENELOPE RUTH (CRNA)
Entity Type:Individual
Prefix:
First Name:PENELOPE
Middle Name:RUTH
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 MADISON
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78204-1320
Mailing Address - Country:US
Mailing Address - Phone:210-508-5231
Mailing Address - Fax:
Practice Address - Street 1:202 MADISON
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78204-1320
Practice Address - Country:US
Practice Address - Phone:210-508-5231
Practice Address - Fax:210-598-5231
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX249232367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered