Provider Demographics
NPI:1568510055
Name:LONG, KAREN L (RN, ANP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:LONG
Suffix:
Gender:F
Credentials:RN, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4402
Mailing Address - Country:US
Mailing Address - Phone:760-745-1551
Mailing Address - Fax:760-745-1588
Practice Address - Street 1:625 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4402
Practice Address - Country:US
Practice Address - Phone:760-745-1551
Practice Address - Fax:760-745-1588
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA272491363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWNP3219BMedicare ID - Type Unspecified
CAP39341Medicare UPIN