Provider Demographics
NPI:1487070033
Name:LONG, REBECCA MARIE (MSN RN CWCN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:LONG
Suffix:
Gender:F
Credentials:MSN RN CWCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POB 100
Mailing Address - Street 2:23915 RD H.5 NW
Mailing Address - City:EPHRATA
Mailing Address - State:WA
Mailing Address - Zip Code:98823
Mailing Address - Country:US
Mailing Address - Phone:509-754-2941
Mailing Address - Fax:509-754-1049
Practice Address - Street 1:23915 RD H.5 NW
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823
Practice Address - Country:US
Practice Address - Phone:509-754-2941
Practice Address - Fax:509-754-1049
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WARN00112120163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care