Healthcare Provider Details

I. General information

NPI: 1265421234
Provider Name (Legal Business Name): PATTI ANN HENDRIX C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 08/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 DEBARR RD
ANCHORAGE AK
99508-2932
US

IV. Provider business mailing address

PO BOX 202149
ANCHORAGE AK
99520-2149
US

V. Phone/Fax

Practice location:
  • Phone: 907-258-2149
  • Fax: 907-258-2147
Mailing address:
  • Phone: 907-258-2149
  • Fax: 907-258-2147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number00070282
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number109966
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number274
License Number StateAK
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number24446
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: