Provider Demographics
NPI:1336361112
Name:LUONGO, AMY C (LPN)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:C
Last Name:LUONGO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 WASHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-4731
Mailing Address - Country:US
Mailing Address - Phone:617-304-8879
Mailing Address - Fax:443-949-8101
Practice Address - Street 1:3300 N RIDGE RD
Practice Address - Street 2:SUITE 175
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3383
Practice Address - Country:US
Practice Address - Phone:410-750-3474
Practice Address - Fax:410-750-3478
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA66567164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse