Provider Demographics
NPI:1962135368
Name:HENKE, AVERY DAWN (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:AVERY
Middle Name:DAWN
Last Name:HENKE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MISS
Other - First Name:AVERY
Other - Middle Name:DAWN
Other - Last Name:HAVERLUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:425 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4033
Mailing Address - Country:US
Mailing Address - Phone:701-426-6765
Mailing Address - Fax:844-605-1801
Practice Address - Street 1:425 N 5TH ST STE 305
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-6300
Practice Address - Country:US
Practice Address - Phone:701-426-6765
Practice Address - Fax:844-605-1801
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR40373363LF0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse