Provider Demographics
NPI:1053509844
Name:LONG, EMILY BETH (CNP)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:BETH
Last Name:LONG
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:111 APPLE BLOSSOM RD SW
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-8697
Mailing Address - Country:US
Mailing Address - Phone:740-964-0092
Mailing Address - Fax:
Practice Address - Street 1:4961 ROBERTS RD
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-8129
Practice Address - Country:US
Practice Address - Phone:614-850-2407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN275072363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHLONP24871Medicare UPIN