1750353082 NPI number — MRS. ELIZABETH MCKINLEY LONG CRNP

Table of content: MRS. ELIZABETH MCKINLEY LONG CRNP (NPI 1750353082)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750353082 NPI number — MRS. ELIZABETH MCKINLEY LONG CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LONG
Provider First Name:
ELIZABETH
Provider Middle Name:
MCKINLEY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750353082
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
TROY UNIVERSITY
Provider Second Line Business Mailing Address:
HAMIL HALL STUDENT HEALTH CENTER
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36082
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-670-3452
Provider Business Mailing Address Fax Number:
334-670-3853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
TROY UNIVERSITY
Provider Second Line Business Practice Location Address:
HAMIL HALL STUDENT HEALTH CENTER
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36082-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-670-3452
Provider Business Practice Location Address Fax Number:
334-670-3853
Provider Enumeration Date:
02/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  1-037867 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 515-30415 . This is a "PROVIDER IDENTIFICATION" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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