Healthcare Provider Details

I. General information

NPI: 1851296818
Provider Name (Legal Business Name): BRIANN LONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2223 WASHINGTON ST UNIT 108
EVANSTON IL
60202-1557
US

IV. Provider business mailing address

6580 MONONA DR # 1180
MONONA WI
53716-4032
US

V. Phone/Fax

Practice location:
  • Phone: 847-404-9495
  • Fax:
Mailing address:
  • Phone: 608-616-0332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License NumberBL026
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: