Basic Information
| Provider Information | |||||||||
| NPI: | 1730346669 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LONGWELL | ||||||||
| FirstName: | ALANA | ||||||||
| MiddleName: | K, | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FEAREY | ||||||||
| OtherFirstName: | ALANA | ||||||||
| OtherMiddleName: | K. | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | D.O. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1301 W 12TH AVE | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | EMPORIA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 668012587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6203432900 | ||||||||
| FaxNumber: | 6203439484 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 W 12TH AVE | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | EMPORIA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 668012587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6203432900 | ||||||||
| FaxNumber: | 6203439484 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2008 | ||||||||
| LastUpdateDate: | 06/06/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 34065 | KS | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 068002125 | 01 | KS | MEDICARE PTAN | OTHER | 200637460C | 05 | KS | MEDICAID |