Individual
CARRIE C. DELONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1372 WESTGATE CENTER DR, WINSTON SALEM, NC 27103-2932
(336) 659-4814
(336) 768-4745
Mailing address
PO BOX 603725, CHARLOTTE, NC 28260-3725
(828) 575-2625
(828) 350-2174
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-01937
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1871725556
—
NC
05
—
1871725556
—
VA
01
—
NNI550A
MEDICARE PTAN
NC
01
—
NNI550A950
MEDICARE PTAN
NC
Enumeration date
08/14/2009
Last updated
10/31/2023
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