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General NPI Number Information
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NPI Number | 1023964483
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Entity Type | Individual
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Provider Name | ROSS HAENTJENS
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Gender |
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Dates
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Enumeration Date | 03/09/2026
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Last Update Date | 03/09/2026
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Provider Practice Location Address
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Address Line | 4401 BOOTH CALLOWAY RD
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City | NORTH RICHLAND HILLS
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State | TX
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Zip | 76180-7371
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Country | US
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Telephone | 817-255-1260
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Fax |
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Provider Business Mailing Address
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Address Line | 4121 JENNY LAKE TRL
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City | FORT WORTH
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State | TX
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Zip | 76244-6923
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 964072
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License Number State | TX
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