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NPI Code Detail

MEDICARE: PAULINE ANN LONG RN

MEDICARE: PAULINE ANN LONG RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WP2201XAmbulatory Care Registered Nurse1113815MN

General Provider Information

NPI Number : 1023845914
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAULINE ANN LONG RN
Provider Business Mailing Address
First Line : 722 NW 7TH ST
Second Line :
City : BRAINERD
State : MN
Zip : 56401-2912
Country : US
Telephone Number : 218-825-2617
Fax Number : 612-725-1302
Provider Business Practice Location Address
First Line : 722 NW 7TH ST
Second Line :
City : BRAINERD
State : MN
Zip : 56401-2912
Country : US
Telephone Number : 218-825-2617
Fax Number : 612-725-1302
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2024
Last Update Date : 03/18/2026

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