Healthcare Provider Details

I. General information

NPI: 1487519005
Provider Name (Legal Business Name): TWYNETTE DENISE LONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 EASTERN AVE NE
WASHINGTON DC
20019-2833
US

IV. Provider business mailing address

9709 KEY WEST AVE APT 386
ROCKVILLE MD
20850-4520
US

V. Phone/Fax

Practice location:
  • Phone: 202-248-2356
  • Fax: 202-978-6143
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: