Provider Demographics
NPI:1982693248
Name:DELONG, MARGIE M (NP)
Entity Type:Individual
Prefix:
First Name:MARGIE
Middle Name:M
Last Name:DELONG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 BROCKWAY RD
Mailing Address - Street 2:1
Mailing Address - City:THOMPSON
Mailing Address - State:OH
Mailing Address - Zip Code:44086-9539
Mailing Address - Country:US
Mailing Address - Phone:440-298-1397
Mailing Address - Fax:
Practice Address - Street 1:54 S STATE ST
Practice Address - Street 2:FAMILY PLANNING ASSOCIATION OF NORTHEAST OHIO SUITE 203
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-3445
Practice Address - Country:US
Practice Address - Phone:440-352-0608
Practice Address - Fax:440-352-0640
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP01040363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCTP01040OtherCERTIFICATE TO PRESCRIBE
OH2343897Medicaid