Provider Demographics
NPI:1306358650
Name:LONG, AMANDA ANN (MSN, RN, CPNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:ANN
Last Name:LONG
Suffix:
Gender:F
Credentials:MSN, RN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 W DORA ST
Mailing Address - Street 2:
Mailing Address - City:ANGIER
Mailing Address - State:NC
Mailing Address - Zip Code:27501-9542
Mailing Address - Country:US
Mailing Address - Phone:919-639-9995
Mailing Address - Fax:
Practice Address - Street 1:285 W DORA ST
Practice Address - Street 2:
Practice Address - City:ANGIER
Practice Address - State:NC
Practice Address - Zip Code:27501-9542
Practice Address - Country:US
Practice Address - Phone:919-639-9995
Practice Address - Fax:919-639-3518
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC247320163W00000X
NC20172101363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse