Individual
LYDIA LOUISE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
701 GROVE RD, GREENVILLE, SC 29605-5611
(864) 455-7000
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
088677
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AN2179
—
SC
01
—
P01026387
RR MEDICARE
SC
01
—
Q384903365
MEDICARE PIN
SC
Enumeration date
12/29/2011
Last updated
06/13/2023
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