Provider Demographics
NPI:1306192109
Name:LONGMIRE, NANCY GAIL
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:GAIL
Last Name:LONGMIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 NC HIGHWAY 242 N
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-7844
Mailing Address - Country:US
Mailing Address - Phone:919-894-2011
Mailing Address - Fax:919-894-7645
Practice Address - Street 1:2503 STAFFORD AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7242
Practice Address - Country:US
Practice Address - Phone:919-834-3323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC114114363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily