Provider Demographics
NPI:1447250394
Name:LONG, MARSHA NADINE (APRN, BC)
Entity type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:NADINE
Last Name:LONG
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 LEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-6213
Mailing Address - Country:US
Mailing Address - Phone:828-837-4712
Mailing Address - Fax:706-258-4141
Practice Address - Street 1:183A LEDFORD ST
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-6213
Practice Address - Country:US
Practice Address - Phone:828-837-4712
Practice Address - Fax:828-837-4808
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC123963363L00000X
GARN093574363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG17295AOtherMEDICARE PTAN
NCNCY510AOtherMEDICARE PTAN
GA107500637HMedicaid