Provider Demographics
NPI:1336220722
Name:LONG, JENNIFER M (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:M
Last Name:LONG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 CEDAR GRV
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-2174
Mailing Address - Country:US
Mailing Address - Phone:203-852-2996
Mailing Address - Fax:203-855-3539
Practice Address - Street 1:24 STEVENS ST
Practice Address - Street 2:NORWALK HOSPITAL
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06856
Practice Address - Country:US
Practice Address - Phone:203-852-2996
Practice Address - Fax:203-855-3539
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002820363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP24019Medicare UPIN
CTOE5441Medicare ID - Type Unspecified