Healthcare Provider Details

I. General information

NPI: 1396239604
Provider Name (Legal Business Name): BARBARA WALTER LONG RN, CDE, CDTC, CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL PARK FAMILY CARE-DIABETES CARE CENTER 2221 E. NORTHERN LIGHTS BLVD. SUITE 118
ANCHORAGE AK
99508
US

IV. Provider business mailing address

PO BOX 230013
ANCHORAGE AK
99523-0013
US

V. Phone/Fax

Practice location:
  • Phone: 907-279-8486
  • Fax: 907-222-7733
Mailing address:
  • Phone: 907-244-4075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number20317
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: