Individual
JOHN A LONGEWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
905 MAIN ST, SUITE 615, KLAMATH FALLS, OR 97601-5810
(541) 851-1757
(541) 273-6357
Mailing address
905 MAIN ST, SUITE 615, KLAMATH FALLS, OR 97601-5810
(541) 851-1757
(541) 273-6357
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
110536
IA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
201150088NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1952592834
—
IA
Enumeration date
08/06/2007
Last updated
12/01/2011
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