Provider Demographics
NPI:1396239604
Name:LONG, BARBARA WALTER (RN, CDE, CDTC, CPT)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:WALTER
Last Name:LONG
Suffix:
Gender:F
Credentials:RN, CDE, CDTC, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 230013
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99523-0013
Mailing Address - Country:US
Mailing Address - Phone:907-244-4075
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL PARK FAMILY CARE-DIABETES CARE CENTER
Practice Address - Street 2:2221 E. NORTHERN LIGHTS BLVD. SUITE 118
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-279-8486
Practice Address - Fax:907-222-7733
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK20317163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1004348Medicaid