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General NPI Number Information
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NPI Number | 1356007355
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Entity Type | Individual
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Provider Name | WILLIAM LONG NP
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Gender | Male
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Dates
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Enumeration Date | 11/14/2021
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Last Update Date | 11/14/2021
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Provider Practice Location Address
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Address Line | 1400 E BOULDER ST STE 500
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-5533
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Country | US
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Telephone | 719-364-6487
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Fax |
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Provider Business Mailing Address
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Address Line | 2472 RAYWOOD VW APT 626
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-7757
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Country | US
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Telephone | 210-213-6897
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | C-APN.0003031-C-NP
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | C-APN.0003031-C-NP
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License Number State | CO
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