Debra J Henke
Individual provider Active NPI Registered Nurse · Antigo, WI
NPI 1194955682 · NPPES record last updated Jul 23, 2009
Key facts
- NPI
- 1194955682
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 158495 (WI)
- Practice address
- W8911 County Rd W
Antigo, WI 54409-9034 - Phone
- (715) 627-0384
- NPI assigned
- Jul 20, 2009
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 158495 | WI | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 158495 | WI | Yes |
Addresses
Primary practice location
W8911 County Rd W
Antigo, WI 54409-9034
Mailing address
W8911 Cty Rd W
Antigo, WI 54409-9034
Phone (715) 627-0384
Other providers in Antigo, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 23, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.