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General NPI Number Information
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NPI Number | 1922923721
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Entity Type | Individual
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Provider Name | SUSAN LEE HENDERSON FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/11/2026
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Last Update Date | 08/11/2026
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Provider Practice Location Address
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Address Line | 12200 RENFERT WAY STE 100
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City | AUSTIN
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State | TX
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Zip | 78758-5654
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Country | US
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Telephone | 512-451-8211
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Fax |
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Provider Business Mailing Address
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Address Line | 10804 REDMOND RD
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City | AUSTIN
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State | TX
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Zip | 78739-1622
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Country | US
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Telephone | 512-831-1449
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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 | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | 1005815
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License Number State | TX
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