Healthcare Provider Details

I. General information

NPI: 1043888340
Provider Name (Legal Business Name): WENDY LONG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2531 OLD ROSEBUD RD
LEXINGTON KY
40509-4574
US

IV. Provider business mailing address

2531 OLD ROSEBUD RD
LEXINGTON KY
40509-4574
US

V. Phone/Fax

Practice location:
  • Phone: 859-543-0337
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number1136273
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: