Healthcare Provider Details

I. General information

NPI: 1326218462
Provider Name (Legal Business Name): MICHAELA V COGAR-LONG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 N HILL RD
SUTTON WV
26601-1147
US

IV. Provider business mailing address

200 JERRY BURTON DR
SUTTON WV
26601-9768
US

V. Phone/Fax

Practice location:
  • Phone: 304-765-7331
  • Fax: 304-765-7976
Mailing address:
  • Phone: 304-765-7331
  • Fax: 304-765-7976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number43046
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: