Healthcare Provider Details

I. General information

NPI: 1417009713
Provider Name (Legal Business Name): SANDRA C. HENKE RN, ANP, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA CATHERINE HENKE ANP

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 12/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25312 INTERSTATE 45 N STE A
SPRING TX
77386
US

IV. Provider business mailing address

25410 INTERSTATE 45 STE A
SPRING TX
77386-1351
US

V. Phone/Fax

Practice location:
  • Phone: 281-367-1414
  • Fax: 281-363-5686
Mailing address:
  • Phone: 281-367-1414
  • Fax: 281-363-5686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number453877
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number453877
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: