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NPI Code Detail

MEDICARE: STEPHANIE J LONG RN

MEDICARE: STEPHANIE J 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
1163WA0400XAddiction (Substance Use Disorder) Registered NurseR45822NM

General Provider Information

NPI Number : 1124955398
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE J LONG RN
Provider Business Mailing Address
First Line : PO BOX 4201
Second Line :
City : ESPANOLA
State : NM
Zip : 87533-4201
Country : US
Telephone Number : 918-794-0101
Fax Number :
Provider Business Practice Location Address
First Line : 1227 N RAILROAD AVE STE C
Second Line :
City : ESPANOLA
State : NM
Zip : 87532-3159
Country : US
Telephone Number : 505-747-8187
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2026
Last Update Date : 05/04/2026

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