Long, Angela L

Long, Angela L is an individual health care provider with primary practice located at 19 Wolf Creek Dr Dept Otolaryngology, Swansea IL 62226-2355. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Long, Angela L can be contacted via phone (618) 235-3687.

Contact Information

Primary practice address
19 Wolf Creek Dr Dept Otolaryngology Swansea IL 62226-2355
Phone: (618) 235-3687
Fax: (618) 239-9492
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 209013742 Illinois

Profile Details

NPI number 1639532609
LBN Legal business name Long, Angela L
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 29th, 2016
Last updated Nov 15th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1639532609 NPPES
Missouri MEDICAID 420078251

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