Provider Demographics
NPI:1477089886
Name:LONG, DEBRA SUE (RN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:SUE
Last Name:LONG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:SUE
Other - Last Name:NESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:812 CALVIN DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3520
Mailing Address - Country:US
Mailing Address - Phone:231-421-1410
Mailing Address - Fax:
Practice Address - Street 1:13194 S CEDAR RD
Practice Address - Street 2:
Practice Address - City:CEDAR
Practice Address - State:MI
Practice Address - Zip Code:49621-9581
Practice Address - Country:US
Practice Address - Phone:231-835-0693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704217360163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health