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General NPI Number Information
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NPI Number | 1225734726
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Entity Type | Individual
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Provider Name | SYDNEY LYNN LONG CPNP-PC
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Gender | Female
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Dates
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Enumeration Date | 02/06/2023
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Last Update Date | 02/06/2024
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Provider Practice Location Address
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Address Line | 725 S 5TH ST
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City | SAINT CHARLES
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State | MO
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Zip | 63301-2913
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Country | US
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Telephone | 636-922-9182
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Fax |
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Provider Business Mailing Address
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Address Line | 809 COLONY RIDGE CT
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City | FORISTELL
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State | MO
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Zip | 63348-1314
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Country | US
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Telephone | 636-614-8707
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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 | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | 2018001392
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 2023006961
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License Number State | MO
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