Healthcare Provider Details

I. General information

NPI: 1033598230
Provider Name (Legal Business Name): MELISSA CHRISTINE LONG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA CHRISTINE STEPHENS PA-C

II. Dates (important events)

Enumeration Date: 05/21/2015
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 DOLBEER ST
EUREKA CA
95501-4736
US

IV. Provider business mailing address

2560 MUNSON ST
EUREKA CA
95501-3365
US

V. Phone/Fax

Practice location:
  • Phone: 707-445-8121
  • Fax:
Mailing address:
  • Phone: 707-832-9439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA52504
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number52504
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: