Provider Demographics
NPI:1811184542
Name:LONG, LORI ANN (RN)
Entity type:Individual
Prefix:MISS
First Name:LORI
Middle Name:ANN
Last Name:LONG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 LINDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-4539
Mailing Address - Country:US
Mailing Address - Phone:419-355-9642
Mailing Address - Fax:419-332-7995
Practice Address - Street 1:924 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-4539
Practice Address - Country:US
Practice Address - Phone:419-355-9642
Practice Address - Fax:419-332-7995
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN219880163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse