Healthcare Provider Details

I. General information

NPI: 1093402414
Provider Name (Legal Business Name): DEANNA LONG LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 OLD LANDING RD
MILLSBORO DE
19966-1210
US

IV. Provider business mailing address

37238 HUDSON RD
SELBYVILLE DE
19975-3403
US

V. Phone/Fax

Practice location:
  • Phone: 302-947-1920
  • Fax:
Mailing address:
  • Phone: 302-258-3528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL2-0011725
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: