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General NPI Number Information
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NPI Number | 1336485051
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Entity Type | Organization
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Legal Business Name | LONG HEALTH FAMILY PRACTICE, LLC
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Dates
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Enumeration Date | 12/27/2012
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Last Update Date | 12/27/2012
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Provider Practice Location Address
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Address Line | 2710 HOSPITAL DR SUITE 108
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City | VICTORIA
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State | TX
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Zip | 77901-5701
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Country | US
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Telephone | 361-579-1319
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Fax | 361-579-1317
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Provider Business Mailing Address
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Address Line | PO BOX 5099
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City | VICTORIA
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State | TX
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Zip | 77903-5099
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Country | US
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Telephone | 361-579-1319
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Fax | 361-579-1317
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ANNETTE LONG
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Credential | NP
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Telephone | 361-935-9250
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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 | 595695
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License Number State | TX
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