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NPI Code Detail

MEDICARE: DEBRA LARAE LONG FNP-C

MEDICARE: DEBRA LARAE LONG FNP-C
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
1363LF0000XFamily Nurse Practitioner091405NC
2363L00000XNurse Practitioner201305NC

General Provider Information

NPI Number : 1508058728
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBRA LARAE LONG FNP-C
Provider Business Mailing Address
First Line : PO BOX 751803
Second Line :
City : CHARLOTTE
State : NC
Zip : 28275-1803
Country : US
Telephone Number : 336-996-2173
Fax Number : 336-996-3254
Provider Business Practice Location Address
First Line : 111 GATEWAY CENTER DR
Second Line :
City : KERNERSVILLE
State : NC
Zip : 27284-2999
Country : US
Telephone Number : 336-996-2173
Fax Number : 336-996-3254
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2007
Last Update Date : 07/23/2013

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