Provider Demographics
NPI:1053642207
Name:LONG, AMY SUE (MS)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:SUE
Last Name:LONG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 E ELM AVE
Mailing Address - Street 2:APT D
Mailing Address - City:COALINGA
Mailing Address - State:CA
Mailing Address - Zip Code:93210-1548
Mailing Address - Country:US
Mailing Address - Phone:559-353-1601
Mailing Address - Fax:
Practice Address - Street 1:7300 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2941
Practice Address - Country:US
Practice Address - Phone:559-448-5544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program