Provider Demographics
NPI:1649980764
Name:LONG, ADDIE A (RT(R)(M)(BD)(ARRT))
Entity type:Individual
Prefix:MRS
First Name:ADDIE
Middle Name:A
Last Name:LONG
Suffix:
Gender:F
Credentials:RT(R)(M)(BD)(ARRT)
Other - Prefix:MRS
Other - First Name:ADDIE
Other - Middle Name:A
Other - Last Name:KIRBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RT(R)(M)(BD)(ARRT)
Mailing Address - Street 1:350 7TH ST N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5754
Mailing Address - Country:US
Mailing Address - Phone:239-734-1337
Mailing Address - Fax:
Practice Address - Street 1:350 7TH ST N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5754
Practice Address - Country:US
Practice Address - Phone:239-734-1337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCRT58413247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty