Provider Demographics
NPI:1871744607
Name:LONGSHORE, CATHERINE ELLEN (APRN, RN)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ELLEN
Last Name:LONGSHORE
Suffix:
Gender:F
Credentials:APRN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 OYSTER REEF DR
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2621
Mailing Address - Country:US
Mailing Address - Phone:843-338-5555
Mailing Address - Fax:
Practice Address - Street 1:15 OYSTER REEF DR
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2621
Practice Address - Country:US
Practice Address - Phone:859-444-7430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-10
Last Update Date:2023-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1055765163WC0400X
SC27925363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner