Provider Demographics
NPI:1093550543
Name:LONG, JEANETTE MARIE (RN)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:MARIE
Last Name:LONG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 W STUART RD
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-1204
Mailing Address - Country:US
Mailing Address - Phone:360-671-5872
Mailing Address - Fax:360-671-5877
Practice Address - Street 1:459 W STUART RD
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-1204
Practice Address - Country:US
Practice Address - Phone:360-671-5872
Practice Address - Fax:360-671-5877
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60863808163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health