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NPI Code Detail

MEDICARE: DEBORAH M LONG F.N.P

MEDICARE: DEBORAH M LONG F.N.P
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 Practitioner0024076084VA

General Provider Information

NPI Number : 1578575031
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORAH M LONG F.N.P
Provider Business Mailing Address
First Line : 3025 BERKMAR DR
Second Line : SUITE 1
City : CHARLOTTESVILLE
State : VA
Zip : 22901-1456
Country : US
Telephone Number : 434-973-1831
Fax Number : 434-973-1919
Provider Business Practice Location Address
First Line : 3025 BERKMAR DR
Second Line : SUITE 1
City : CHARLOTTESVILLE
State : VA
Zip : 22901-1456
Country : US
Telephone Number : 434-973-1831
Fax Number : 434-973-1919
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2006
Last Update Date : 11/07/2011

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