Individual
ANGELA M LONG
Active
Individual
ANGELA M LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R73939
AR
367500000X
Certified Registered Nurse Anesthetist
Primary
CO2708
AR
367500000X
Certified Registered Nurse Anesthetist
CTP000068
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1124286877
BCBS OF AR
AR
05
—
174706001
—
AR
01
—
P00628608
RR MEDICARE GROUP CG8899
AR
Enumeration date
05/29/2008
Last updated
05/18/2009
Update your record
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