Provider Demographics
NPI:1821657339
Name:LONG, HEIDI H (DOULA)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:H
Last Name:LONG
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 NE 35TH PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-7658
Mailing Address - Country:US
Mailing Address - Phone:415-240-1742
Mailing Address - Fax:
Practice Address - Street 1:4920 NE 35TH PL
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-7658
Practice Address - Country:US
Practice Address - Phone:415-240-1742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-08
Last Update Date:2019-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula