Basic Information
| Provider Information | |||||||||
| NPI: | 1144664152 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HENDRIX | ||||||||
| FirstName: | BRANDON | ||||||||
| MiddleName: | ZED | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 BRANDYWINE LN | ||||||||
| Address2: | |||||||||
| City: | ANDERSON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296255653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8649349167 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 SAINT FRANCIS DR | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296013955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642551000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2013 | ||||||||
| LastUpdateDate: | 05/27/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 204464 | SC | N | Nursing Service Providers | Registered Nurse | 367500000X | 18277 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.