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General NPI Number Information
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NPI Number | 1962851337
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Entity Type | Individual
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Provider Name | BARBRA LONG GRADUS FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 06/07/2016
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Last Update Date | 09/02/2021
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Provider Practice Location Address
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Address Line | 84 MADRONE ST
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City | WILLITS
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State | CA
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Zip | 95490-4249
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Country | US
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Telephone | 707-456-3062
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Fax | 707-456-3063
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Provider Business Mailing Address
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Address Line | 84 MADRONE ST
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City | WILLITS
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State | CA
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Zip | 95490-4249
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Country | US
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Telephone | 707-456-3062
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Fax | 707-456-3063
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95016871
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License Number State | CA
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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 | F340298-1
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License Number State | NY
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