Provider Demographics
NPI:1194955682
Name:HENKE, DEBRA J
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:J
Last Name:HENKE
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:W8911 CTY RD W
Mailing Address - Street 2:
Mailing Address - City:ANTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54409-9034
Mailing Address - Country:US
Mailing Address - Phone:715-627-0384
Mailing Address - Fax:
Practice Address - Street 1:W8911 COUNTY RD W
Practice Address - Street 2:
Practice Address - City:ANTIGO
Practice Address - State:WI
Practice Address - Zip Code:54409-9034
Practice Address - Country:US
Practice Address - Phone:715-627-0384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI158495163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse