Individual
MS. KATHERINE MARIE LONGORIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP, RN
Contact information
Practice address
2680 W CENTRE AVE, PORTAGE, MI 49024-4828
(269) 324-2400
(269) 324-0450
Mailing address
2680 W CENTRE AVE, PORTAGE, MI 49024-4828
(269) 324-2400
(269) 324-0450
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
4704250766
MI
363LP0200X
Pediatric Nurse Practitioner
Primary
4704250766
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275887051
—
MI
01
—
1801818752
BCBSM - BMG
MI
Enumeration date
11/01/2012
Last updated
11/13/2020
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