Provider Demographics
NPI:1942462379
Name:LONG, DEBORAH JEAN (ARNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:JEAN
Last Name:LONG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:JEAN
Other - Last Name:RASMUSSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8181 N CORNERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8752
Mailing Address - Country:US
Mailing Address - Phone:208-772-0785
Mailing Address - Fax:
Practice Address - Street 1:8181 N CORNERSTONE DR
Practice Address - Street 2:
Practice Address - City:HAYDEN LAKE
Practice Address - State:ID
Practice Address - Zip Code:83835-8752
Practice Address - Country:US
Practice Address - Phone:208-772-0785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-867A363L00000X
WAAP60029232363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner