| Doctor Name: | JEANETTE LONGENDYKE |
| NPI Number: | 1568809572 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 395443 |
| Business Practice Address: | 803 Grant Ave Lake Katrine, NY - 124495352 |
| Business Phone Number: | 8453315064 |
| Business Fax Number: | |
| Mailing Address: | 803 Grant Ave, LAKE KATRINE |
| State: | NY |
| Postal Code: | 124495352 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 05/30/2013 |
| NPI Last Update Date: | 05/30/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WH0200X |
| License Number: | 395443 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Home Health |
| Taxonomy Definition: | |