Provider Demographics
NPI:1669837522
Name:LONG, MARIA (APRN FNP BC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:APRN FNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 FLETCHER AVE
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-3021
Mailing Address - Country:US
Mailing Address - Phone:402-709-6878
Mailing Address - Fax:
Practice Address - Street 1:208 FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-3021
Practice Address - Country:US
Practice Address - Phone:402-709-6878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-20
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA112937363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily