Provider Demographics
NPI:1508278896
Name:LONG, SHIREEN (APRN, DNP)
Entity Type:Individual
Prefix:DR
First Name:SHIREEN
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:APRN, DNP
Other - Prefix:MRS
Other - First Name:SHIREEN
Other - Middle Name:V
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:6524 HOFFMAN TER
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-1414
Mailing Address - Country:US
Mailing Address - Phone:847-791-7654
Mailing Address - Fax:
Practice Address - Street 1:2909 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2004
Practice Address - Country:US
Practice Address - Phone:847-791-7654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209011591363L00000X, 363LF0000X
IL277000033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily