Individual
PATTI D LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NNP
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-0001
(843) 792-1414
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-1414
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1026
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP0796
—
SC
Enumeration date
08/29/2006
Last updated
11/16/2020
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