Provider Demographics
NPI:1386712958
Name:ARNOLD LONG, MARY CAROLEEN (RN CNS)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CAROLEEN
Last Name:ARNOLD LONG
Suffix:
Gender:F
Credentials:RN CNS
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CAROLEEN
Other - Last Name:ARNOLD ANDRYCHUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN CNS
Mailing Address - Street 1:4177 EASTLAKE DR
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-8985
Mailing Address - Country:US
Mailing Address - Phone:513-398-4095
Mailing Address - Fax:
Practice Address - Street 1:15 W GALBRAITH RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45216
Practice Address - Country:US
Practice Address - Phone:513-679-8483
Practice Address - Fax:513-984-5897
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA05714NS364S00000X
IN28127221A364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2404795Medicaid
OHARNS01991Medicare ID - Type Unspecified