Provider Demographics
NPI:1932715570
Name:LONG, JULIE RENEE (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:RENEE
Last Name:LONG
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 PEARSON DR
Mailing Address - Street 2:
Mailing Address - City:GENOA
Mailing Address - State:IL
Mailing Address - Zip Code:60135-1383
Mailing Address - Country:US
Mailing Address - Phone:815-784-6437
Mailing Address - Fax:815-784-3933
Practice Address - Street 1:599 PEARSON DR
Practice Address - Street 2:
Practice Address - City:GENOA
Practice Address - State:IL
Practice Address - Zip Code:60135-1383
Practice Address - Country:US
Practice Address - Phone:815-784-6437
Practice Address - Fax:815-784-3933
Is Sole Proprietor?:No
Enumeration Date:2020-09-18
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209021324363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily