Provider Demographics
NPI:1417134099
Name:LONGCHAMPS, MARIE REGINA (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:REGINA
Last Name:LONGCHAMPS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 SAINT PAULS ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-1206
Mailing Address - Country:US
Mailing Address - Phone:516-442-5681
Mailing Address - Fax:
Practice Address - Street 1:1230 SAINT PAULS ST
Practice Address - Street 2:
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-1206
Practice Address - Country:US
Practice Address - Phone:516-442-5681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-26
Last Update Date:2008-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY455456-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health