Provider Demographics
NPI:1811223142
Name:LONG, CARMEN MICHELE
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:MICHELE
Last Name:LONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 EAGLE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-4775
Mailing Address - Country:US
Mailing Address - Phone:832-741-8333
Mailing Address - Fax:713-779-2904
Practice Address - Street 1:3009 EAGLE LAKE DR
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-4775
Practice Address - Country:US
Practice Address - Phone:832-741-8333
Practice Address - Fax:713-779-2904
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies