Provider Demographics
NPI:1043566755
Name:LONG, MOIRA L (DNP, MSN, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:MOIRA
Middle Name:L
Last Name:LONG
Suffix:
Gender:F
Credentials:DNP, MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 PHEASANT HILL CIR
Mailing Address - Street 2:
Mailing Address - City:COTUIT
Mailing Address - State:MA
Mailing Address - Zip Code:02635-2546
Mailing Address - Country:US
Mailing Address - Phone:508-241-0923
Mailing Address - Fax:
Practice Address - Street 1:311 DORIC AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-2903
Practice Address - Country:US
Practice Address - Phone:401-467-9610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN229242363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily