Provider Demographics
NPI:1437877768
Name:LONG, LAILA NICOLE (CRNP)
Entity Type:Individual
Prefix:
First Name:LAILA
Middle Name:NICOLE
Last Name:LONG
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 UNIVERSITY DR
Mailing Address - Street 2:MC CA410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2360
Mailing Address - Country:US
Mailing Address - Phone:717-531-1726
Mailing Address - Fax:717-531-0119
Practice Address - Street 1:51 BUSINESS CAMPUS WAY STE 200
Practice Address - Street 2:
Practice Address - City:DUNCANNON
Practice Address - State:PA
Practice Address - Zip Code:17020-9596
Practice Address - Country:US
Practice Address - Phone:717-834-3108
Practice Address - Fax:717-834-6911
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP026153363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner