Provider Demographics
NPI:1760710149
Name:HANCKE, THEODOOR CHRISTIAAN (CRNA)
Entity Type:Individual
Prefix:
First Name:THEODOOR
Middle Name:CHRISTIAAN
Last Name:HANCKE
Suffix:
Gender:M
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:PO BOX 650252
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0252
Mailing Address - Country:US
Mailing Address - Phone:888-804-3000
Mailing Address - Fax:817-334-0235
Practice Address - Street 1:850 HIGHWAY 243 WEST
Practice Address - Street 2:
Practice Address - City:KAUFMAN
Practice Address - State:TX
Practice Address - Zip Code:75142
Practice Address - Country:US
Practice Address - Phone:972-932-7200
Practice Address - Fax:817-861-3926
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX713757367500000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse