Provider Demographics
NPI:1609966688
Name:ARDOIN, ANDREW (CRNA)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:ARDOIN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3703 DRUMMOND ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-2417
Mailing Address - Country:US
Mailing Address - Phone:713-553-3983
Mailing Address - Fax:
Practice Address - Street 1:1211 HIGHWAY 6
Practice Address - Street 2:SOUTH SUITE 70
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4941
Practice Address - Country:US
Practice Address - Phone:228-547-7747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX650241367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS000019377AOtherBCBS
MS4032778Medicaid
MS000019377AOtherBCBS