Provider Demographics
NPI:1881654747
Name:HENKE, RAE (RN06 11 1964)
Entity Type:Individual
Prefix:
First Name:RAE
Middle Name:
Last Name:HENKE
Suffix:
Gender:F
Credentials:RN06 11 1964
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 5TH ST E
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-2215
Mailing Address - Country:US
Mailing Address - Phone:715-209-1925
Mailing Address - Fax:
Practice Address - Street 1:W 6604 HWY 64
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451
Practice Address - Country:US
Practice Address - Phone:715-748-0914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WC0400XNursing Service ProvidersRegistered NurseCase Management