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General NPI Number Information
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NPI Number | 1619015047
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Entity Type | Individual
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Provider Name | SALLY ANN CARLL-LONG NP
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Gender | Female
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 326 NICHOLS RD SUITE 26
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City | FITCHBURG
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State | MA
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Zip | 01420-1914
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Country | US
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Telephone | 978-345-6272
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 TURNPIKE RD UNIT 6
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City | NEW IPSWICH
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State | NH
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Zip | 03071-3030
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Country | US
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Telephone | 603-878-0965
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 169432
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License Number State | MA
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