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NPI Code Detail

MEDICARE: TODD RUSSELL HENDERSON CRNA

MEDICARE:   TODD RUSSELL HENDERSON  CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist55469KS

General Provider Information

NPI Number : 1801864657
Entity Type Code : Individual
Provider Name (Legal Business Name) : TODD RUSSELL HENDERSON CRNA
Provider Business Mailing Address
First Line : 452 CHEYENNE CT
Second Line :
City : KECHI
State : KS
Zip : 67067-8630
Country : US
Telephone Number : 316-841-7042
Fax Number :
Provider Business Practice Location Address
First Line : 452 CHEYENNE CT
Second Line :
City : KECHI
State : KS
Zip : 67067-8630
Country : US
Telephone Number : 316-841-7042
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2006
Last Update Date : 10/31/2008

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Directions to “ TODD RUSSELL HENDERSON CRNA” Practice Location

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