Healthcare Provider Details

I. General information

NPI: 1275062598
Provider Name (Legal Business Name): MEMORY MDLONGWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2017
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1681 BRICE CT
CROFTON MD
21114-1610
US

IV. Provider business mailing address

601 MEMORY LN
YORK PA
17402-2231
US

V. Phone/Fax

Practice location:
  • Phone: 317-698-0405
  • Fax: 317-698-0405
Mailing address:
  • Phone: 717-851-1405
  • Fax: 717-851-6969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR225465
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: