Provider Demographics
NPI:1669883229
Name:LONGWELL, MARISA (RN)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:LONGWELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:
Other - Last Name:STUART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:1634 1/2 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2018
Mailing Address - Country:US
Mailing Address - Phone:412-956-9274
Mailing Address - Fax:
Practice Address - Street 1:5230 CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1304
Practice Address - Country:US
Practice Address - Phone:412-623-1040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN610777163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse