MEDICARE: SAMANTHA LONG APN-CNP

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	363L00000X	Nurse Practitioner	209012497	IL
2	363LP2300X	Primary Care Nurse Practitioner	209.012497	IL

General Provider Information

NPI Number	:	1962897082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA LONG APN-CNP

Provider Business Mailing Address
First Line	:	2150 PFINGSTEN RD STE 1200
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60026-1326
Country	:	US
Telephone Number	:	847-864-3278
Fax Number	:

Provider Business Practice Location Address
First Line	:	2150 PFINGSTEN RD STE 1200
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60026-1326
Country	:	US
Telephone Number	:	847-864-3278
Fax Number	:

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

Provider Enumeration Date	:	04/06/2015
Last Update Date	:	04/10/2026

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