Healthcare Provider Details

I. General information

NPI: 1932767621
Provider Name (Legal Business Name): AMY HENKE REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 MAIN STREET
DALTON NE
69131-6913
US

IV. Provider business mailing address

PO BOX 297
DALTON NE
69131-0297
US

V. Phone/Fax

Practice location:
  • Phone: 308-377-2301
  • Fax: 308-377-2304
Mailing address:
  • Phone: 308-377-2301
  • Fax: 308-377-2304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number55860
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: