Healthcare Provider Details

I. General information

NPI: 1235056623
Provider Name (Legal Business Name): CORAL HENKE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 VETERANS DR
SAINT CLOUD MN
56303-2015
US

IV. Provider business mailing address

13999 125TH AVE NE
FOLEY MN
56329-9230
US

V. Phone/Fax

Practice location:
  • Phone: 320-255-6349
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number827346
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: