MEDICARE: KATELYN HENK RN, BSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WS0200X	School Registered Nurse	201861-30	WI

General Provider Information

NPI Number	:	1962272914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN HENK RN, BSN

Provider Business Mailing Address
First Line	:	30 PHIPPS AVE
Second Line	:
City	:	RICE LAKE
State	:	WI
Zip	:	54868-1996
Country	:	US
Telephone Number	:	608-606-9215
Fax Number	:	715-234-4552

Provider Business Practice Location Address
First Line	:	30 PHIPPS AVE
Second Line	:
City	:	RICE LAKE
State	:	WI
Zip	:	54868-1996
Country	:	US
Telephone Number	:	608-606-9215
Fax Number	:	715-234-4552

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2024
Last Update Date	:	05/28/2026

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