Provider Demographics
NPI:1497588214
Name:LONG, KATHERINE RAE (374J00000X DOULA)
Entity type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:RAE
Last Name:LONG
Suffix:
Gender:F
Credentials:374J00000X DOULA
Other - Prefix:MISS
Other - First Name:KATHERINE
Other - Middle Name:RAE
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DOULA 812990
Mailing Address - Street 1:9755 SILVER SKY PKWY APT 307
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-2119
Mailing Address - Country:US
Mailing Address - Phone:775-842-5848
Mailing Address - Fax:
Practice Address - Street 1:9755 SILVER SKY PKWY APT 307
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89506-2119
Practice Address - Country:US
Practice Address - Phone:775-842-5848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20243188577374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula