Healthcare Provider Details

I. General information

NPI: 1962272914
Provider Name (Legal Business Name): KATELYN HENK RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PHIPPS AVE
RICE LAKE WI
54868-1996
US

IV. Provider business mailing address

30 PHIPPS AVE
RICE LAKE WI
54868-1996
US

V. Phone/Fax

Practice location:
  • Phone: 608-606-9215
  • Fax: 715-234-4552
Mailing address:
  • Phone: 608-606-9215
  • Fax: 715-234-4552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number201861-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: