Provider Demographics
NPI:1114012226
Name:LONG, GERALDINE LOWEEN (RN, NP)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:LOWEEN
Last Name:LONG
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KS
Mailing Address - Zip Code:66097-4003
Mailing Address - Country:US
Mailing Address - Phone:913-774-4340
Mailing Address - Fax:913-774-8605
Practice Address - Street 1:408 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KS
Practice Address - Zip Code:66097-4003
Practice Address - Country:US
Practice Address - Phone:913-774-4340
Practice Address - Fax:913-774-8605
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44989363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily