Provider Demographics
NPI:1952300170
Name:LONG, MARY NASH (APRN-BC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:NASH
Last Name:LONG
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
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Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-0388
Mailing Address - Country:US
Mailing Address - Phone:540-932-5162
Mailing Address - Fax:540-932-5875
Practice Address - Street 1:78 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939
Practice Address - Country:US
Practice Address - Phone:540-245-7230
Practice Address - Fax:540-245-7235
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2019-10-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO088814363LF0000X
VA0024178286363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP94529Medicare UPIN
MO816561068Medicare ID - Type Unspecified