Individual provider Active NPI

Victoria Leona Longstreth, ARNP

  • Family Nurse Practitioner
  • Everett, WA
National Provider Identifier
1366927253
Registry record updated Sep 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP60897701 Issued in WA
Practice address
12728 19TH Ave SE
Everett, WA 98208-6526
Phone
(425) 317-8025
NPI assigned
Sep 26, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP60897701 WA Primary

Addresses

Primary practice location

12728 19TH Ave SE
Everett, WA 98208-6526

Mailing address

12728 19TH Ave SE
Everett, WA 98208-6526
Phone (425) 317-8025

Other names 1

  • Miss Victoria Leona Laudahl Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190125002790 WA Practitioner - Nurse Practitioner 7810234036 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Western Washington Medical Group Inc PSGroup PAC ID 7517870314, 111 clinicians

Practice addresses (Care Compare)

4225 Hoyt Ave
Suite D
Everett, WA 98203-2351
Phone (425) 317-8025

Hospital & facility affiliations

  • Providence at Home With Compassus, Snohomish County Home health agency, Everett, WA, CCN 507065
  • Providence Regional Medical Center Everett Hospital, Everett, WA, CCN 500014

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Western Washington Medical Group, Inc PS Current Accepting new patients
Western Washington Medical Group, Inc PS CurrentSince Oct 15, 2018 Accepting new patients
Western Washington Medical Group, Inc PS CurrentSince Oct 15, 2018 Accepting new patients
Western Washington Medical Group, Inc PS Past Accepting new patients

Locations

4225 Hoyt Ave
Ste D
Everett, WA 98203
Phone (425) 258-3622

4225 Hoyt Ave
Ste A
Everett, WA 98203
Phone (425) 259-3122

12728 19th Ave SE
Ste 300
Everett, WA 98208
Phone (425) 252-1116

1728 W Marine View Dr
Ste 110
Everett, WA 98201
Phone (425) 259-4041

Interoperability endpoints

  • Direct secure messaging: vlongstreth726902@direct.multicare.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1537920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537920000000",
    "number": "1366927253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12728 19TH AVE SE",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982086526",
            "telephone_number": "425-317-8025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12728 19TH AVE SE",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982086526",
            "telephone_number": "425-317-8025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONGSTRETH",
        "first_name": "VICTORIA",
        "middle_name": "LEONA",
        "name_prefix": "Mrs.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-26",
        "last_updated": "2018-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP60897701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VICTORIA",
            "last_name": "LAUDAHL",
            "middle_name": "LEONA",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Everett, WA

Sources for this page

Verify at the official NPI Registry.