Healthcare Provider Details

I. General information

NPI: 1639310808
Provider Name (Legal Business Name): TANYA LONG R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2009
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RIVERSIDE CIR
HAYESVILLE NC
28904-7946
US

IV. Provider business mailing address

870 HOT HOUSE RD
HAYESVILLE NC
28904-5131
US

V. Phone/Fax

Practice location:
  • Phone: 828-389-8052
  • Fax: 828-389-8533
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number096495
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: