Provider Demographics
NPI:1346243938
Name:LONG, VICKI E (CNM)
Entity type:Individual
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First Name:VICKI
Middle Name:E
Last Name:LONG
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Gender:F
Credentials:CNM
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Mailing Address - Street 1:2000 MEDICAL PKWY
Mailing Address - Street 2:STE 304
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3745
Mailing Address - Country:US
Mailing Address - Phone:410-573-9530
Mailing Address - Fax:410-573-9569
Practice Address - Street 1:2000 MEDICAL PKWY
Practice Address - Street 2:STE 304
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3745
Practice Address - Country:US
Practice Address - Phone:410-573-9530
Practice Address - Fax:410-573-9569
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2010-10-18
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Provider Licenses
StateLicense IDTaxonomies
MDR078036367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife