Provider Demographics
NPI:1285622126
Name:HENINGER, ANDREA LEE (CRNA)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LEE
Last Name:HENINGER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:LEE
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:13601 PRESTON RD
Mailing Address - Street 2:#1000W
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-4911
Mailing Address - Country:US
Mailing Address - Phone:972-715-5007
Mailing Address - Fax:972-715-5682
Practice Address - Street 1:729 BEDFORD EULESS RD W
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-3939
Practice Address - Country:US
Practice Address - Phone:817-282-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH150915367500000X
TX036954367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207153201Medicaid
OH2231892Medicaid
TX8608UUOtherBCBS
OH2231892Medicaid
OHFO8007833Medicare PIN