Provider Demographics
NPI:1629213624
Name:LONGTIN, KARRIANN MARIE (APRN PMHNP CPNP-AC)
Entity Type:Individual
Prefix:
First Name:KARRIANN
Middle Name:MARIE
Last Name:LONGTIN
Suffix:
Gender:F
Credentials:APRN PMHNP CPNP-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1482 NORTHFIELD MEADOWS BLVD
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-4612
Mailing Address - Country:US
Mailing Address - Phone:815-592-3122
Mailing Address - Fax:
Practice Address - Street 1:1482 NORTHFIELD MEADOWS BLVD
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-4612
Practice Address - Country:US
Practice Address - Phone:815-592-3122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277.002464363LP0808X
IL209007369363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health