Individual
LISA D HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
302 UNIVERSITY BLVD, ROUND ROCK, TX 78665-1032
(512) 509-0200
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 724-2111
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
52984
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007150801
—
TX
05
—
152834101
—
TX
05
—
152834104
—
TX
05
—
152834106
—
TX
01
—
88060U
BLUE CROSS
—
Enumeration date
11/18/2005
Last updated
03/03/2023
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