Provider Demographics
NPI:1932767621
Name:HENKE, AMY (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HENKE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:NE
Mailing Address - Zip Code:69131-0297
Mailing Address - Country:US
Mailing Address - Phone:308-377-2301
Mailing Address - Fax:308-377-2304
Practice Address - Street 1:504 MAIN STREET
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:NE
Practice Address - Zip Code:69131-6913
Practice Address - Country:US
Practice Address - Phone:308-377-2301
Practice Address - Fax:308-377-2304
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE55860163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse