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Individual

ANGELA M LONG

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
1910 MALVERN AVE, HOT SPRINGS, AR 71901-7752
(800) 235-1415
(913) 234-1108
Mailing address
PO BOX 22390, HOT SPRINGS, AR 71903-2390
(800) 235-1415
(913) 234-1108

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
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