Provider Demographics
NPI:1811228117
Name:LONG, CARLEEN K (LPN)
Entity Type:Individual
Prefix:MS
First Name:CARLEEN
Middle Name:K
Last Name:LONG
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9050 LAUTENSCHLAGER RD
Mailing Address - Street 2:
Mailing Address - City:APPLE CREEK
Mailing Address - State:OH
Mailing Address - Zip Code:44606-9704
Mailing Address - Country:US
Mailing Address - Phone:330-473-5541
Mailing Address - Fax:330-698-0313
Practice Address - Street 1:9050 LAUTENSCHLAGER RD
Practice Address - Street 2:
Practice Address - City:APPLE CREEK
Practice Address - State:OH
Practice Address - Zip Code:44606-9704
Practice Address - Country:US
Practice Address - Phone:330-473-5541
Practice Address - Fax:330-698-0313
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN120130164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse