Provider Demographics
NPI:1669652129
Name:LONG, ROSIE (LPN,IBCLC,RLC)
Entity Type:Individual
Prefix:
First Name:ROSIE
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:LPN,IBCLC,RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12624 MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-1765
Mailing Address - Country:US
Mailing Address - Phone:405-830-9166
Mailing Address - Fax:405-271-6454
Practice Address - Street 1:825 NE 10TH ST # 3300
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5417
Practice Address - Country:US
Practice Address - Phone:405-271-9494
Practice Address - Fax:405-271-3727
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist