Healthcare Provider Details

I. General information

NPI: 1639272974
Provider Name (Legal Business Name): VALERIE F LONG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DULCE HEALTH CENTER 12000 STONE LAKE ROAD
DULCE NM
87528-0187
US

IV. Provider business mailing address

PO BOX 187
DULCE NM
87528-0187
US

V. Phone/Fax

Practice location:
  • Phone: 505-759-3291
  • Fax: 505-759-7289
Mailing address:
  • Phone: 505-759-3291
  • Fax: 505-759-7289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number103762
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number103762
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: