Healthcare Provider Details

I. General information

NPI: 1215568225
Provider Name (Legal Business Name): AN K LONG CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 8TH AVE # PA
BETHLEHEM PA
18018-2256
US

IV. Provider business mailing address

801 OSTRUM ST
BETHLEHEM PA
18015-1000
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-5210
  • Fax: 866-568-6561
Mailing address:
  • Phone: 484-526-5210
  • Fax: 866-568-6561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP021419
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: