Provider Demographics
NPI:1861447831
Name:LONGWAY, CYNTHIA POMINVILLE (PCNS)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:POMINVILLE
Last Name:LONGWAY
Suffix:
Gender:F
Credentials:PCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WEST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02817-1563
Mailing Address - Country:US
Mailing Address - Phone:401-397-3488
Mailing Address - Fax:401-235-9091
Practice Address - Street 1:250 EDDIE DOWLING HWY
Practice Address - Street 2:UNIT # 6
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-8228
Practice Address - Country:US
Practice Address - Phone:401-235-9089
Practice Address - Fax:401-235-9091
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPPNS 00028163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIS44847Medicare UPIN
RI8990235932Medicare ID - Type Unspecified