Healthcare Provider Details

I. General information

NPI: 1386712958
Provider Name (Legal Business Name): MARY CAROLEEN ARNOLD LONG RN CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY CAROLEEN ARNOLD ANDRYCHUK RN CNS

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 W GALBRAITH RD
CINCINNATI OH
45216
US

IV. Provider business mailing address

4177 EASTLAKE DR
MASON OH
45040-8985
US

V. Phone/Fax

Practice location:
  • Phone: 513-679-8483
  • Fax: 513-984-5897
Mailing address:
  • Phone: 513-398-4095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberCOA05714NS
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number28127221A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: