Long, Lysa

Long, Lysa is an individual health care provider with primary practice located at 5933 Blakeney Park Dr Ste 100 , Charlotte NC 28277-5713. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife, which is considered as her primary health care specialty. Long, Lysa can be contacted via phone (704) 316-2021.

Contact Information

Primary practice address
5933 Blakeney Park Dr Ste 100 Charlotte NC 28277-5713
Phone: (704) 316-2021
Fax: (704) 316-2025
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife 367A00000X 185 North Carolina

Profile Details

NPI number 1619110418
LBN Legal business name Long, Lysa
Credentials Certified Nurse Midwife (CNM)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 9th, 2009
Last updated Oct 25th, 2020 - about 5 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 1619110418 NPPES
North Carolina MEDICAID 7002154

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