Basic Information
| Provider Information | |||||||||
| NPI: | 1760710149 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANCKE | ||||||||
| FirstName: | THEODOOR | ||||||||
| MiddleName: | CHRISTIAAN | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 650252 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752650252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888043000 | ||||||||
| FaxNumber: | 8173340235 | ||||||||
| Practice Location | |||||||||
| Address1: | 850 HIGHWAY 243 WEST | ||||||||
| Address2: | |||||||||
| City: | KAUFMAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729327200 | ||||||||
| FaxNumber: | 8178613926 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2009 | ||||||||
| LastUpdateDate: | 10/22/2010 | ||||||||
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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 | 367500000X | 713757 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 163W00000X | 713757 | TX | N | Nursing Service Providers | Registered Nurse |
No ID Information.