Healthcare Provider Details

I. General information

NPI: 1366971228
Provider Name (Legal Business Name): EMILY ANN LONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 10/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEWISH HOSPITAL PLZ
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

5300 CENTRAL GARDENS WAY APT 201
PALM BEACH GARDENS FL
33418-4080
US

V. Phone/Fax

Practice location:
  • Phone: 314-747-3000
  • Fax:
Mailing address:
  • Phone: 636-485-2305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9468918
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: