Provider Demographics
NPI:1093191777
Name:HENEMAN, AUSTIN JAMES (PA-C)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:JAMES
Last Name:HENEMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2720 FAIRVIEW AVE N STE 200
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1306
Mailing Address - Country:US
Mailing Address - Phone:651-633-6883
Mailing Address - Fax:651-331-3459
Practice Address - Street 1:2720 FAIRVIEW AVE N STE 200
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1306
Practice Address - Country:US
Practice Address - Phone:651-633-6883
Practice Address - Fax:651-331-3459
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN11882363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant