Longoria, Katherine Marie

Longoria, Katherine Marie is an individual health care provider with primary practice located at 2680 W Centre Ave , Portage MI 49024-4828. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Pediatrics, Physician Assistants & Advanced Practice Nursing Providers / Pediatrics. Physician Assistants & Advanced Practice Nursing Providers / Pediatrics is her primary health care specialty. Longoria, Katherine Marie can be contacted via phone (269) 324-2400.

Contact Information

Primary practice address
2680 W Centre Ave Portage MI 49024-4828
Phone: (269) 324-2400
Fax: (269) 324-0450
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Pediatrics 163WP0200X 4704250766 Michigan
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 4704250766 Michigan

Profile Details

NPI number 1275887051
LBN Legal business name Longoria, Katherine Marie
Credentials PNP, RN
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 1st, 2012
Last updated Nov 13th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1275887051 NPPES
Michigan MEDICAID 1275887051
Michigan Other 1801818752

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