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General NPI Number Information
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NPI Number | 1205691367
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Entity Type | Individual
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Provider Name | NINA RAE LONG CRNP
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Gender | Female
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Dates
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Enumeration Date | 02/19/2024
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 1809 KRESS ST
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City | CULLMAN
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State | AL
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Zip | 35058-1565
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Country | US
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Telephone | 256-739-1210
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Fax | 256-739-1204
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Provider Business Mailing Address
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Address Line | 491 SHERWOOD PL
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City | HALEYVILLE
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State | AL
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Zip | 35565-6958
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Country | US
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Telephone | 205-485-4615
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1-171850
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License Number State | AL
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