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General NPI Number Information
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NPI Number | 1508278896
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Entity Type | Individual
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Provider Name | SHIREEN LONG APRN, DNP
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Gender | Female
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Dates
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Enumeration Date | 05/21/2014
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Last Update Date | 10/11/2019
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Provider Practice Location Address
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Address Line | 2909 MACARTHUR BLVD
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City | NORTHBROOK
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State | IL
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Zip | 60062-2004
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Country | US
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Telephone | 847-791-7654
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Fax |
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Provider Business Mailing Address
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Address Line | 6524 HOFFMAN TER
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City | MORTON GROVE
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State | IL
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Zip | 60053-1414
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Country | US
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Telephone | 847-791-7654
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209011591
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209011591
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 277000033
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License Number State | IL
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