Provider Demographics
NPI:1912919291
Name:LONGDON, MARLENE C (NP)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:C
Last Name:LONGDON
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:6255 SHERIDAN DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4836
Mailing Address - Country:US
Mailing Address - Phone:716-857-8666
Mailing Address - Fax:716-857-8944
Practice Address - Street 1:6245 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-4834
Practice Address - Country:US
Practice Address - Phone:716-630-1205
Practice Address - Fax:716-250-5954
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF401008-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000528698001OtherHEALTH NOW
NY9513978OtherINDEPENDENT HEALTH
NY9513978OtherINDEPENDENT HEALTH