Basic Information
| Provider Information | |||||||||
| NPI: | 1740521277 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HENDREN | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | CHRISTINE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CRNA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BERKERY | ||||||||
| OtherFirstName: | MARY | ||||||||
| OtherMiddleName: | CHRISTINE | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 320 WHITTINGTON PKWY | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402224928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026255584 | ||||||||
| FaxNumber: | 5024262264 | ||||||||
| Practice Location | |||||||||
| Address1: | 320 WHITTINGTON PKWY | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402224928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026255584 | ||||||||
| FaxNumber: | 5024262264 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2013 | ||||||||
| LastUpdateDate: | 03/22/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 3007975 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 163W00000X | 1101547 | KY | N | Nursing Service Providers | Registered Nurse |
No ID Information.