Healthcare Provider Details

I. General information

NPI: 1598026890
Provider Name (Legal Business Name): MARK WILLIAM LONGALE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2012
Last Update Date: 06/21/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 W 82ND PL UNIT D
WESTMINSTER CO
80031-4010
US

IV. Provider business mailing address

2420 W 82ND PL UNIT D
WESTMINSTER CO
80031-4010
US

V. Phone/Fax

Practice location:
  • Phone: 303-907-7086
  • Fax:
Mailing address:
  • Phone: 303-907-7086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number200394
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: