Provider Demographics
NPI:1639364441
Name:LONG, SARAH E (APRN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:LONG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 NORTHAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-4098
Mailing Address - Country:US
Mailing Address - Phone:413-858-7400
Mailing Address - Fax:413-746-0380
Practice Address - Street 1:30 NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-4098
Practice Address - Country:US
Practice Address - Phone:413-858-7400
Practice Address - Fax:413-746-0380
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT077985163W00000X
CT003671363LF0000X
MARN2268959363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004236346Medicaid
D400000012Medicare PIN