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General NPI Number Information
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NPI Number | 1952879868
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Entity Type | Organization
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Legal Business Name | VANESSA LONG APRN INC
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Dates
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Enumeration Date | 11/08/2018
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Last Update Date | 06/10/2024
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Provider Practice Location Address
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Address Line | 3261 24TH AVE NW STE 101
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City | NORMAN
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State | OK
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Zip | 73069-6666
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Country | US
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Telephone | 405-251-7338
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Fax | 405-444-3965
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Provider Business Mailing Address
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Address Line | 14201 W SUNRISE BLVD STE 208
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City | SUNRISE
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State | FL
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Zip | 33323-3207
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Country | US
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Telephone | 405-251-7338
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Fax | 405-444-3965
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Authorized Official
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Title or Position | OWNER, PRESIDENT
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Name | MRS. VANESSA LONG
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Credential | APRN-CNP
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Telephone | 405-822-0074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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