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General NPI Number Information
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NPI Number | 1952429672
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Entity Type | Individual
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Provider Name | PATRICIA LYNN LONG CNP, CNS
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Gender | Female
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 06/03/2015
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Provider Practice Location Address
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Address Line | 368 NORTHEAST AVE
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City | TALLMADGE
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State | OH
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Zip | 44278-1443
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Country | US
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Telephone | 216-906-4923
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Fax |
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Provider Business Mailing Address
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Address Line | 368 NORTHEAST AVE
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City | TALLMADGE
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State | OH
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Zip | 44278-1443
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Country | US
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Telephone | 216-906-4923
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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 | NP09090
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 364SG0600X
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Taxonomy Name | Gerontology Clinical Nurse Specialist
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License Number | NS07470
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License Number State | OH
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