Carmen Renee Grande Henke, CNNP

Primary specialty

Neonatal Nurse PractitionerTaxonomy code 363LN0000X

License

R1475155 Issued in MN

Practice address

347 North Smith Avenue
Childrens Specialty Clinic Nicu
St Paul, MN 55102

Phone

(651) 220-6210

Fax

(651) 220-7777

NPI assigned

Apr 22, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• North Memorial Health Care

  • Clinic/Center
  • Blaine, MN
  • NPI 1841995552
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482105600000",
    "number": "1205892833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2910 CENTRE POINTE DRIVE",
            "address_2": "35 121A",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "55113",
            "telephone_number": "651-855-2327",
            "fax_number": "651-855-2310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "347 NORTH SMITH AVENUE",
            "address_2": "CHILDRENS SPECIALTY CLINIC NICU",
            "city": "ST PAUL",
            "state": "MN",
            "postal_code": "55102",
            "telephone_number": "651-220-6210",
            "fax_number": "651-220-7777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENKE",
        "first_name": "CARMEN",
        "middle_name": "RENEE GRANDE",
        "credential": "CNNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-22",
        "last_updated": "2016-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LN0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal",
            "state": "MN",
            "license": "R1475155",
            "primary": true
        },
        {
            "code": "363LN0005X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal, Critical Care",
            "state": "MN",
            "license": "R1475155",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "318656300",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Devin Rae Hendrickson, LICSW
• Kassie Hendrickson, MSW, LICSW
• Paige Lynn Hendrickson
• Tyler Ramonda Hendrickson, LICSW
• Stephanie Lynn Henigin, MA, CCC-SLP
• Daniel A. Henkel, MT
• Roy Henline, LPN
• Kari Hennen, PT
• Mark Hennen, OD
• John Charles Hennessey, M.D.

• Neonatal Nurse Practitioner in St Paul, MN
• Providers in St Paul, MN by specialty
• Neonatal Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.