Provider Demographics
NPI:1750353082
Name:LONG, ELIZABETH MCKINLEY (CRNP)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MCKINLEY
Last Name:LONG
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:TROY UNIVERSITY
Mailing Address - Street 2:HAMIL HALL STUDENT HEALTH CENTER
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36082
Mailing Address - Country:US
Mailing Address - Phone:334-670-3452
Mailing Address - Fax:334-670-3853
Practice Address - Street 1:TROY UNIVERSITY
Practice Address - Street 2:HAMIL HALL STUDENT HEALTH CENTER
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36082-0001
Practice Address - Country:US
Practice Address - Phone:334-670-3452
Practice Address - Fax:334-670-3853
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-037867363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-30415OtherPROVIDER IDENTIFICATION