Provider Demographics
NPI:1194305375
Name:LONG, ALEXANDRIA NICOLE (RD)
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRIA
Middle Name:NICOLE
Last Name:LONG
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 LITTLE RAVEN ST APT 565
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-7177
Mailing Address - Country:US
Mailing Address - Phone:267-424-3372
Mailing Address - Fax:
Practice Address - Street 1:1900 LITTLE RAVEN ST APT 565
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-7177
Practice Address - Country:US
Practice Address - Phone:267-424-3372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered