Provider Demographics
NPI:1093528580
Name:LONGWELL, SCOTT WAYNE
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:WAYNE
Last Name:LONGWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 HEARTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26571-0010
Mailing Address - Country:US
Mailing Address - Phone:304-986-1941
Mailing Address - Fax:
Practice Address - Street 1:12 HEARTWOOD LN
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:WV
Practice Address - Zip Code:26571-0010
Practice Address - Country:US
Practice Address - Phone:304-986-1941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant