Provider Demographics
NPI:1295049187
Name:LONGFELLOW, KAREN ALISHYA (FNP)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:ALISHYA
Last Name:LONGFELLOW
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:44 MATHEWS AVE
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5233
Mailing Address - Country:US
Mailing Address - Phone:207-788-0475
Mailing Address - Fax:
Practice Address - Street 1:5 CENTRAL MAINE XING
Practice Address - Street 2:
Practice Address - City:GARDINER
Practice Address - State:ME
Practice Address - Zip Code:04345-6320
Practice Address - Country:US
Practice Address - Phone:207-582-6608
Practice Address - Fax:207-582-2258
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP101048363LF0000X
MEAP101048363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily