Provider Demographics
NPI:1760189633
Name:LONG, ELIZABETH CHARLENE (CDT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:CHARLENE
Last Name:LONG
Suffix:
Gender:F
Credentials:CDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6333 E SKELLY DR
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-6106
Mailing Address - Country:US
Mailing Address - Phone:918-798-5487
Mailing Address - Fax:
Practice Address - Street 1:5903 E 35TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-5305
Practice Address - Country:US
Practice Address - Phone:918-798-5487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician