Provider Demographics
NPI:1669509923
Name:LONGSTRETH, FATMATA NANCY (RN)
Entity Type:Individual
Prefix:
First Name:FATMATA
Middle Name:NANCY
Last Name:LONGSTRETH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:FATMATA
Other - Middle Name:NANCY
Other - Last Name:LONGSTRETH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:100 WARD STREET
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2366 WINCHESTER LOOP
Practice Address - Street 2:
Practice Address - City:DISCOVERY BAY
Practice Address - State:CA
Practice Address - Zip Code:94514-1855
Practice Address - Country:US
Practice Address - Phone:925-335-4707
Practice Address - Fax:925-335-4718
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA548100163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse