Provider Demographics
NPI:1396257762
Name:FURLONG, SHIRLEY ANN (VN)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:ANN
Last Name:FURLONG
Suffix:
Gender:F
Credentials:VN
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:ANN
Other - Last Name:OTERO-FURLONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTERO-FURLONG
Mailing Address - Street 1:ALHAMBRA SCHOOL DISTRICT NO 68
Mailing Address - Street 2:4510 N 37TH AVENUE
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85019
Mailing Address - Country:US
Mailing Address - Phone:602-336-2990
Mailing Address - Fax:602-336-2271
Practice Address - Street 1:ALHAMBRA SCHOOL DISTRICT NO 68
Practice Address - Street 2:4510 N 37TH AVENUE
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85019
Practice Address - Country:US
Practice Address - Phone:602-336-2990
Practice Address - Fax:602-336-2271
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-25
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPN054782164W00000X
CA693674164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ86-6000510OtherAHCCCS ADMINISTRATOR COUNTY OF MARICOPA ALHAMBRA SCHOOL DISTRICT NO 68
AZ1093938441OtherAHCCCS