Healthcare Provider Details

I. General information

NPI: 1972722346
Provider Name (Legal Business Name): CARMEN MICHELLE LONG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N ST NE
AUBURN WA
98002-4418
US

IV. Provider business mailing address

101 N ST NE
AUBURN WA
98002-4418
US

V. Phone/Fax

Practice location:
  • Phone: 206-697-7994
  • Fax:
Mailing address:
  • Phone: 206-697-7994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN00152455
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: