Provider Demographics
NPI:1235852385
Name:LONG, ASHLEY J (ND)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:J
Last Name:LONG
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 NE 86TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-5911
Mailing Address - Country:US
Mailing Address - Phone:208-949-0440
Mailing Address - Fax:
Practice Address - Street 1:604 MAUNA LOA HWY BUILDING C
Practice Address - Street 2:
Practice Address - City:KAUNAKAKAI
Practice Address - State:HI
Practice Address - Zip Code:96748
Practice Address - Country:US
Practice Address - Phone:808-560-3653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR113-OB175F00000X
175F00000X
OR5007175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath