Provider Demographics
NPI:1811645377
Name:LONGBINE, DARLENE ANN
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:ANN
Last Name:LONGBINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:NM
Mailing Address - Zip Code:88418-0032
Mailing Address - Country:US
Mailing Address - Phone:315-534-4915
Mailing Address - Fax:
Practice Address - Street 1:500 DES MOINES AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:NM
Practice Address - Zip Code:88418
Practice Address - Country:US
Practice Address - Phone:575-278-2611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-76919163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse