Healthcare Provider Details

I. General information

NPI: 1285899849
Provider Name (Legal Business Name): CHRISTINA MARIEKE LONG D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 REID ST
TACOMA WA
98431-1100
US

IV. Provider business mailing address

9040 REID ST
TACOMA WA
98431-1100
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-0198
  • Fax: 253-968-3278
Mailing address:
  • Phone: 253-968-0198
  • Fax: 253-968-3278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number237960-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: