Individual
MRS. ANGELA M. LONGEVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
925 WEST ST, PERU, IL 61354-2757
(815) 223-3300
(815) 223-3394
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
(800) 893-9698
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209018462
IL
Other
Enumeration date
10/12/2018
Last updated
12/05/2019
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