Provider Demographics
NPI:1205101987
Name:FURLONG, KATHLEEN MARIE (NP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARIE
Last Name:FURLONG
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:26522 LA ALAMEDA
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6330
Mailing Address - Country:US
Mailing Address - Phone:949-282-1671
Mailing Address - Fax:949-367-0518
Practice Address - Street 1:26800 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE 275
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6384
Practice Address - Country:US
Practice Address - Phone:949-542-8002
Practice Address - Fax:949-542-7337
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2021-10-22
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Provider Licenses
StateLicense IDTaxonomies
CA579745363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFY391ZMedicare PIN
CAFY391YMedicare PIN