Basic Information
| Provider Information | |||||||||
| NPI: | 1487965075 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUONGO | ||||||||
| FirstName: | ANTOINETTE | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1203 LANGHORNE NEWTOWN RD | ||||||||
| Address2: | ST. CLARE MEDICAL BUILDING SUITE 138 | ||||||||
| City: | LANGHORNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190471209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1215741314 | ||||||||
| FaxNumber: | 1215743143 | ||||||||
| Practice Location | |||||||||
| Address1: | 1203 LANGHORNE NEWTOWN RD | ||||||||
| Address2: | ST. CLARE MEDICAL BUILDING SUITE 138 | ||||||||
| City: | LANGHORNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190471209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157413141 | ||||||||
| FaxNumber: | 2157413143 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2010 | ||||||||
| LastUpdateDate: | 06/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | TP004156C | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.