Provider Demographics
NPI:1669663688
Name:JUNE S. LONGWAY, PMHNP, BC, LLC
Entity Type:Organization
Organization Name:JUNE S. LONGWAY, PMHNP, BC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:LONGWAY
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:503-325-2813
Mailing Address - Street 1:10 PIER 1
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-6300
Mailing Address - Country:US
Mailing Address - Phone:503-325-2813
Mailing Address - Fax:503-325-2929
Practice Address - Street 1:10 PIER 1
Practice Address - Street 2:SUITE 202
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-6300
Practice Address - Country:US
Practice Address - Phone:503-325-2813
Practice Address - Fax:503-325-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS 25586Medicare UPIN