Provider Demographics
NPI:1407576333
Name:LONGABAUGH, MORGAN (NP)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:LONGABAUGH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE BOX 679-B
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-341-7800
Mailing Address - Fax:
Practice Address - Street 1:140 CANAL VIEW BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-5317
Practice Address - Country:US
Practice Address - Phone:585-341-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY349625363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner