Provider Demographics
NPI:1902533441
Name:LONGO, MADELINE ELIZABETH (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:ELIZABETH
Last Name:LONGO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 BRANCH AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-2737
Mailing Address - Country:US
Mailing Address - Phone:401-606-2590
Mailing Address - Fax:
Practice Address - Street 1:66 BRANCH AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2737
Practice Address - Country:US
Practice Address - Phone:401-606-2590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN03183363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily