Provider Demographics
NPI:1194944231
Name:LONGBONS, JOANNE T (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:T
Last Name:LONGBONS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7590 AUBURN ROAD, SUITE 014
Mailing Address - Street 2:ATTN: MED STAFF SERVICES
Mailing Address - City:CONCORD TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44077-9176
Mailing Address - Country:US
Mailing Address - Phone:440-354-1899
Mailing Address - Fax:440-354-1845
Practice Address - Street 1:36100 EUCLID AVENUE
Practice Address - Street 2:SUITE 170
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094
Practice Address - Country:US
Practice Address - Phone:440-602-6737
Practice Address - Fax:440-942-0316
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2021-08-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH50.000470363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00829222OtherRAILROAD MEDICARE
OHP78482Medicare UPIN
OHPA14602Medicare PIN