Healthcare Provider Details

I. General information

NPI: 1699688986
Provider Name (Legal Business Name): CRYSTAL W LONGORIA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 HIGHLAND DR
MANY LA
71449-3718
US

IV. Provider business mailing address

699 TWIN SPRINGS LOOP
ZWOLLE LA
71486-3864
US

V. Phone/Fax

Practice location:
  • Phone: 318-256-5691
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number215457
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: