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Individual

MS. KATHERINE MARIE LONGORIA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PNP, RN

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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