Provider Demographics
NPI:1013990159
Name:LONG, DEBRA STORLIEN (RD,LD,CNSD)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:STORLIEN
Last Name:LONG
Suffix:
Gender:F
Credentials:RD,LD,CNSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 N PIEDRAS ST
Mailing Address - Street 2:WILLIAM BEAUMONT ARMY MEDICAL ATTN: CREDENTIALS OFFICE
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79920-5001
Mailing Address - Country:US
Mailing Address - Phone:915-569-1382
Mailing Address - Fax:915-569-1233
Practice Address - Street 1:8009 TONTO PL
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79904-3123
Practice Address - Country:US
Practice Address - Phone:915-757-2338
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT027777133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered