Healthcare Provider Details

I. General information

NPI: 1326588963
Provider Name (Legal Business Name): LAURA J. LONG CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA J. ADAMS CRNA

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 FRANKLIN AVE
NORMAL IL
61761-3551
US

IV. Provider business mailing address

611 W PARK ST
URBANA IL
61801-2501
US

V. Phone/Fax

Practice location:
  • Phone: 309-268-5867
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209015674
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: