Provider Demographics
NPI:1619182565
Name:LONG, AURELIA G MENDIOLA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:AURELIA
Middle Name:G MENDIOLA
Last Name:LONG
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MS
Other - First Name:AURELIA
Other - Middle Name:
Other - Last Name:GUTIERREZ-LONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:P.O. BOX 5723 CHRB
Mailing Address - Street 2:
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950
Mailing Address - Country:US
Mailing Address - Phone:670-783-2468
Mailing Address - Fax:670-256-5244
Practice Address - Street 1:5 CANAL STREET, SAN JOSE
Practice Address - Street 2:
Practice Address - City:TINIAN
Practice Address - State:MP
Practice Address - Zip Code:96952
Practice Address - Country:US
Practice Address - Phone:670-433-4750
Practice Address - Fax:670-433-4751
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MP0046363LW0102X
MPNP08005363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health