MEDICARE: JANAE MARIE LONG

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	376K00000X	Nurse's Aide		OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7718982	OTHER	OH	CONTRACT NUMBER

General Provider Information

NPI Number	:	1982205464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANAE MARIE LONG

Provider Business Mailing Address
First Line	:	970 WHITTIER AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-2159
Country	:	US
Telephone Number	:	330-285-1791
Fax Number	:

Provider Business Practice Location Address
First Line	:	970 WHITTIER AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-2159
Country	:	US
Telephone Number	:	330-285-1791
Fax Number	:

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

Provider Enumeration Date	:	11/02/2020
Last Update Date	:	11/02/2020

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Directions to “ JANAE MARIE LONG ” Practice Location

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