Provider Demographics
NPI:1942062021
Name:VARHOLDT, JAMES R JR (CNP)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:VARHOLDT
Suffix:JR
Gender:
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6405 FRANCE AVE S STE W200
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2186
Mailing Address - Country:US
Mailing Address - Phone:612-365-5000
Mailing Address - Fax:
Practice Address - Street 1:6405 FRANCE AVE S STE W200
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2186
Practice Address - Country:US
Practice Address - Phone:612-365-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-25
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2325835163WC0200X
MN11958363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine