Provider Demographics
NPI:1326218462
Name:COGAR-LONG, MICHAELA V (RN)
Entity Type:Individual
Prefix:MS
First Name:MICHAELA
Middle Name:V
Last Name:COGAR-LONG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 JERRY BURTON DR
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:WV
Mailing Address - Zip Code:26601-9768
Mailing Address - Country:US
Mailing Address - Phone:304-765-7331
Mailing Address - Fax:304-765-7976
Practice Address - Street 1:411 N HILL RD
Practice Address - Street 2:
Practice Address - City:SUTTON
Practice Address - State:WV
Practice Address - Zip Code:26601-1147
Practice Address - Country:US
Practice Address - Phone:304-765-7331
Practice Address - Fax:304-765-7976
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV43046163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool