Individual
LESLIE DIANNE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
3680 MIDWAY DR, BAKER CITY, OR 97814-1466
(541) 523-4049
(541) 523-4062
Mailing address
3425 13TH ST, BAKER CITY, OR 97814-1340
(541) 523-7400
(541) 523-4927
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
096007256RN
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
096007256RN
STATE LICENSE
OR
Enumeration date
06/22/2021
Last updated
06/22/2021
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