Individual
LISA LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
201 CEDAR ST SE STE 304, ALBUQUERQUE, NM 87106-4932
(505) 843-7813
Mailing address
800 BRADBURY DR SE STE 116, ALBUQUERQUE, NM 87106-4310
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2018-0086
NM
Other
Enumeration date
05/14/2018
Last updated
01/06/2026
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