Provider Demographics
NPI:1700558046
Name:LONGWELL, MICHAEL (APRN)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:LONGWELL
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 PINE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43953-3301
Mailing Address - Country:US
Mailing Address - Phone:304-374-5664
Mailing Address - Fax:
Practice Address - Street 1:12 ELM TER
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5064
Practice Address - Country:US
Practice Address - Phone:304-905-8695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV118804363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health