MEDICARE: MS. RUTHIE ANITA LONG APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN102300 APO6121	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649573932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RUTHIE ANITA LONG APRN

Provider Business Mailing Address
First Line	:	64629 HIGHWAY 41
Second Line	:
City	:	PEARL RIVER
State	:	LA
Zip	:	70452-3611
Country	:	US
Telephone Number	:	985-863-7100
Fax Number	:	985-863-0085

Provider Business Practice Location Address
First Line	:	64629 HIGHWAY 41
Second Line	:
City	:	PEARL RIVER
State	:	LA
Zip	:	70452-3611
Country	:	US
Telephone Number	:	985-863-7100
Fax Number	:	985-863-0085

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2010
Last Update Date	:	06/18/2015

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