Provider Demographics
NPI:1417009713
Name:HENKE, SANDRA C (RN, ANP, CNS)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:C
Last Name:HENKE
Suffix:
Gender:F
Credentials:RN, ANP, CNS
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:CATHERINE
Other - Last Name:HENKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ANP
Mailing Address - Street 1:25410 INTERSTATE 45 STE A
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-1351
Mailing Address - Country:US
Mailing Address - Phone:281-367-1414
Mailing Address - Fax:281-363-5686
Practice Address - Street 1:25312 INTERSTATE 45 N STE A
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386
Practice Address - Country:US
Practice Address - Phone:281-367-1414
Practice Address - Fax:281-363-5686
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX453877364S00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87N594OtherBCBS
TXP00136149OtherRR MEDICARE
TX042597701Medicaid
TX87N594OtherBCBS
P04131Medicare UPIN