Provider Demographics
NPI:1790502052
Name:HENDRY, CONNIE S
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:S
Last Name:HENDRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 HEARTLEAF RD
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-4291
Mailing Address - Country:US
Mailing Address - Phone:210-865-4836
Mailing Address - Fax:
Practice Address - Street 1:244 HEARTLEAF RD
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-4291
Practice Address - Country:US
Practice Address - Phone:210-865-4836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-26
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX673721163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse