Individual
EVALINE RUTH LONGWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
975 E. THIRD ST, CHATTANOOGA, TN 37403-2147
(423) 778-7608
(423) 778-2360
Mailing address
PO BOX 11225, CHATTANOOGA, TN 37401-2225
(423) 892-5602
(423) 892-5838
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN51734
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
APN11715
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3636471
—
TN
01
—
4115500
BLUE CROSS BLUE SHIELD TN
TN
05
—
642252208A
—
GA
01
—
N354957
WELLCARE (GA MEDICAID)
GA
Enumeration date
01/29/2007
Last updated
02/01/2010
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