Individual
STEPHANIE SUE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1808 W MAIN ST, RUSSELLVILLE, AR 72801-2724
(479) 968-2841
Mailing address
PO BOX 1351, RUSSELLVILLE, AR 72811-1351
(800) 235-1415
(913) 234-1108
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
C01566
AR
367500000X
Certified Registered Nurse Anesthetist
CTP161
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
160268001
—
AR
01
—
5Y760
BCBS OF AR
AR
01
—
771014101
AR BREASTCARE
AR
01
—
P00377263
RR MEDICARE GROUP #CC5970
—
Enumeration date
02/01/2006
Last updated
06/03/2008
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