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General NPI Number Information
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NPI Number | 1124955398
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Entity Type | Individual
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Provider Name | STEPHANIE J LONG RN
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Gender | Female
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Dates
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Enumeration Date | 05/04/2026
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Last Update Date | 05/04/2026
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Provider Practice Location Address
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Address Line | 1227 N RAILROAD AVE STE C
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City | ESPANOLA
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State | NM
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Zip | 87532-3159
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Country | US
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Telephone | 505-747-8187
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4201
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City | ESPANOLA
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State | NM
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Zip | 87533-4201
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Country | US
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Telephone | 918-794-0101
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
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License Number | R45822
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License Number State | NM
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