Provider Demographics
NPI:1104704204
Name:LONGHENRY, JAMES
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:LONGHENRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 DUCKWOOD DR STE 500
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1399
Mailing Address - Country:US
Mailing Address - Phone:715-307-8774
Mailing Address - Fax:
Practice Address - Street 1:1440 DUCKWOOD DR STE 500
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1399
Practice Address - Country:US
Practice Address - Phone:715-307-8774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10938175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist