Provider Demographics
NPI:1790910172
Name:DELONG, LAURIE A (LPN)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:DELONG
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7429 SHALLOWFORD RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2629
Mailing Address - Country:US
Mailing Address - Phone:423-305-2560
Mailing Address - Fax:423-308-2561
Practice Address - Street 1:7429 SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2629
Practice Address - Country:US
Practice Address - Phone:423-308-2560
Practice Address - Fax:423-308-2561
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN73992164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse