Healthcare Provider Details

I. General information

NPI: 1558226258
Provider Name (Legal Business Name): MICHELLE A LONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2709 7TH AVE W
WILLISTON ND
58801-2903
US

IV. Provider business mailing address

2709 7TH AVE W
WILLISTON ND
58801-2903
US

V. Phone/Fax

Practice location:
  • Phone: 701-334-3189
  • Fax:
Mailing address:
  • Phone: 701-334-3189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: