Provider Demographics
NPI:1982205464
Name:LONG, JANAE MARIE
Entity Type:Individual
Prefix:
First Name:JANAE
Middle Name:MARIE
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 1:970 WHITTIER AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-2159
Mailing Address - Country:US
Mailing Address - Phone:330-285-1791
Mailing Address - Fax:
Practice Address - Street 1:970 WHITTIER AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-2159
Practice Address - Country:US
Practice Address - Phone:330-285-1791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7718982OtherCONTRACT NUMBER