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Carmen Renee Grande Henke

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

347 North Smith Avenue, Childrens Specialty Clinic Nicu, St Paul, MN 55102

PECOS Enrollment

This provider is enrolled in PECOS as CARMEN HENKE.

Based on the most recent information from CMS, provider Carmen Renee Grande Henke is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1205892833
Provider Type
Individual
Full Name
Henke, Carmen Renee Grande
Credential
CNNP

Gender
Female
Sole Proprietor
No
Enumeration Date
4/22/2006
Last Updated
12/19/2016

Contact Information

Practice Location

347 North Smith Avenue, Childrens Specialty Clinic Nicu, St Paul, MN 55102

(651) 220-6210

(651) 220-7777

Mailing Location

2910 Centre Pointe Drive, 35 121a, Roseville, MN 55113

(651) 855-2327

(651) 855-2310

Provider Taxonomies

Code	Description	License
Code 363LN0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License R1475155 Minnesota
Code 363LN0005X	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License R1475155 Minnesota

Provider Identifiers

ID	Description	Issuer
ID 318656300	Description Medicaid	Issuer Unlisted Minnesota

Carmen Renee Grande Henke

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Hermes, Shea M

Latta, Caitlin Marie

Borden, Patra Ann

Lesslie, Debra L

Jaynes, Heather M

Liukonen, Tanya

Vergen, Kari M

Schmidt, Diane M