Provider Demographics
NPI:1750457339
Name:LONG, LAURA JANE (LAURA LONG, RN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JANE
Last Name:LONG
Suffix:
Gender:F
Credentials:LAURA LONG, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 NE 3RD ST
Mailing Address - Street 2:#106-350
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3854
Mailing Address - Country:US
Mailing Address - Phone:541-948-0103
Mailing Address - Fax:
Practice Address - Street 1:21428 HYDE LN
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-9569
Practice Address - Country:US
Practice Address - Phone:541-948-0103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health