Provider Demographics
NPI:1114473006
Name:LONG, LORI DELYNE
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:DELYNE
Last Name:LONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 9TH STREET
Mailing Address - Street 2:
Mailing Address - City:RYAN
Mailing Address - State:OK
Mailing Address - Zip Code:73565
Mailing Address - Country:US
Mailing Address - Phone:580-591-1573
Mailing Address - Fax:
Practice Address - Street 1:1700 9TH ST
Practice Address - Street 2:
Practice Address - City:RYAN
Practice Address - State:OK
Practice Address - Zip Code:73565-9705
Practice Address - Country:US
Practice Address - Phone:580-591-1573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator