MEDICARE: ASHLEY LONG

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
1	164W00000X	Licensed Practical Nurse	120086	AK

General Provider Information

NPI Number	:	1619408770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY LONG

Provider Business Mailing Address
First Line	:	3705 ARCTIC BLVD # 2237
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-5774
Country	:	US
Telephone Number	:	907-223-1233
Fax Number	:

Provider Business Practice Location Address
First Line	:	3705 ARCTIC BLVD # 2237
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-5774
Country	:	US
Telephone Number	:	907-223-1233
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2017
Last Update Date	:	03/21/2017

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Directions to “ ASHLEY LONG ” Practice Location

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