Provider Demographics
NPI:1578575031
Name:LONG, DEBORAH M (FNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:M
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 1:3025 BERKMAR DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1456
Mailing Address - Country:US
Mailing Address - Phone:434-973-1831
Mailing Address - Fax:434-973-1919
Practice Address - Street 1:3025 BERKMAR DR
Practice Address - Street 2:SUITE 1
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1456
Practice Address - Country:US
Practice Address - Phone:434-973-1831
Practice Address - Fax:434-973-1919
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024076084363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
R60680Medicare UPIN
50000035Medicare ID - Type Unspecified