Provider Demographics
NPI:1003663212
Name:HENKEL, TEDAN HU
Entity type:Individual
Prefix:MRS
First Name:TEDAN
Middle Name:HU
Last Name:HENKEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TEDAN
Other - Middle Name:
Other - Last Name:HU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-6400
Mailing Address - Fax:414-955-0213
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-6400
Practice Address - Fax:404-955-0213
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7972-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant