Provider Demographics
NPI:1316751415
Name:LONGEWAY, NICHOLE TERESE (FNP)
Entity type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:TERESE
Last Name:LONGEWAY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:NICHOLE
Other - Middle Name:TERESE
Other - Last Name:WARRING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10914 KELSO CT
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-9459
Mailing Address - Country:US
Mailing Address - Phone:209-840-1107
Mailing Address - Fax:
Practice Address - Street 1:795 MORNING STAR DR
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5193
Practice Address - Country:US
Practice Address - Phone:209-536-3680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95033869363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily