Individual
MRS. NICOLE MARIE LUONGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
6720 BERTNER AVE, HOUSTON, TX 77030-2604
(832) 355-2666
Mailing address
PO BOX 4439, HOUSTON, TX 77210-4439
(713) 792-2991
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP121512 / RN 813254
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
296900801
—
TX
01
—
8686UC
BCBS
TX
Enumeration date
11/14/2011
Last updated
09/21/2022
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