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NPI Code Detail

MEDICARE: MRS. CAROLYN H LONG CRNP

MEDICARE:  MRS. CAROLYN H LONG  CRNP
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
1363L00000XNurse Practitioner0001078167VA
2363L00000XNurse PractitionerRN41947DC

General Provider Information

NPI Number : 1124182274
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CAROLYN H LONG CRNP
Provider Business Mailing Address
First Line : 2101 EAST JEFFERSON STREET
Second Line : PPQA MEDICARE COMPLIANCE UNIT 6 WEST KAISER PERMANENTE
City : ROCKVILLE
State : MD
Zip : 20852-4908
Country : US
Telephone Number : 301-816-6660
Fax Number : 301-816-6308
Provider Business Practice Location Address
First Line : 2100 W PENNSYLVANIA AVE
Second Line :
City : WASHINGTON
State : DC
Zip : 20037-3202
Country : US
Telephone Number : 202-872-7232
Fax Number : 202-872-7212
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. CAROLYN H LONG CRNP” Practice Location

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