Provider Demographics
NPI:1457374944
Name:HENDRYX, DONALD J (CRNA)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:J
Last Name:HENDRYX
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 1:602 HOLBROOK ST
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-5502
Mailing Address - Country:US
Mailing Address - Phone:512-642-6979
Mailing Address - Fax:
Practice Address - Street 1:305 MALLARD LN
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:TX
Practice Address - Zip Code:76574-1208
Practice Address - Country:US
Practice Address - Phone:512-352-7611
Practice Address - Fax:512-352-4734
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX248973367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX002288101Medicaid
80625CMedicare ID - Type Unspecified
TX002288101Medicaid