Provider Demographics
NPI:1447471909
Name:LONG, INGRID RENE (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:INGRID
Middle Name:RENE
Last Name:LONG
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 SCISSOMTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WHITWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37397-6601
Mailing Address - Country:US
Mailing Address - Phone:423-658-9975
Mailing Address - Fax:
Practice Address - Street 1:295 SCISSOMTOWN RD
Practice Address - Street 2:
Practice Address - City:WHITWELL
Practice Address - State:TN
Practice Address - Zip Code:37397-6601
Practice Address - Country:US
Practice Address - Phone:423-658-9975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000105970163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health