Provider Demographics
NPI:1902244304
Name:LONGHENRY, DEBORAH ANNE (RN)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:ANNE
Last Name:LONGHENRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:ANNE
Other - Last Name:JEKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:W198S8525 BENDINGBRAE DR
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-8155
Mailing Address - Country:US
Mailing Address - Phone:262-679-4661
Mailing Address - Fax:
Practice Address - Street 1:W198S8525 BENDINGBRAE DR
Practice Address - Street 2:
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150-8155
Practice Address - Country:US
Practice Address - Phone:262-679-4661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI195165-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse