Basic Information
| Provider Information | |||||||||
| NPI: | 1922604560 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LONGENECKER | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | RICHARD | ||||||||
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| Credential: | MSN, RN, AGACNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 519 N HIGH ST | ||||||||
| Address2: | |||||||||
| City: | COVINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453181415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375702328 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1 AKRON GENERAL AVE | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443072432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303446000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2020 | ||||||||
| LastUpdateDate: | 01/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 240801 | TN | N | Nursing Service Providers | Registered Nurse | 163W00000X | 484230 | OH | N | Nursing Service Providers | Registered Nurse | 363LA2100X | 28513 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363LA2100X | 0028218 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.