Provider Demographics
NPI:1598026890
Name:LONGALE, MARK WILLIAM (RN)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:WILLIAM
Last Name:LONGALE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 W 82ND PL
Mailing Address - Street 2:UNIT D
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-4010
Mailing Address - Country:US
Mailing Address - Phone:303-907-7086
Mailing Address - Fax:
Practice Address - Street 1:2420 W 82ND PL
Practice Address - Street 2:UNIT D
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-4010
Practice Address - Country:US
Practice Address - Phone:303-907-7086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO200394163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice