Provider Demographics
NPI:1033285713
Name:HERLONG, RITA (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:RITA
Middle Name:
Last Name:HERLONG
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5785
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-0785
Mailing Address - Country:US
Mailing Address - Phone:503-363-4506
Mailing Address - Fax:503-362-3607
Practice Address - Street 1:4035 12TH STREET CUTOFF
Practice Address - Street 2:SUIT120
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1764
Practice Address - Country:US
Practice Address - Phone:503-363-4506
Practice Address - Fax:503-362-3607
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000033561N6363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR157161Medicare PIN