Provider Demographics
NPI:1568440725
Name:LONG, SHARON E (FNP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:E
Last Name:LONG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12150 30 MILE ROAD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48095-3203
Mailing Address - Country:US
Mailing Address - Phone:586-752-7256
Mailing Address - Fax:586-331-2323
Practice Address - Street 1:12150 30 MILE RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48095-2035
Practice Address - Country:US
Practice Address - Phone:586-752-7256
Practice Address - Fax:586-331-2323
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704131779363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI10-4599457Medicaid
MI10-4599466Medicaid
MI10-4599484Medicaid
MI10-4599500Medicaid
MI10-4599475Medicaid
MI10-4599493Medicaid
MI10-4599457Medicaid
MI10-4599475Medicaid
MI10-4599500Medicaid