Provider Demographics
NPI:1699088062
Name:LONG, LAVAY CHRSITINE (STUDENT HYGIENIST)
Entity type:Individual
Prefix:
First Name:LAVAY
Middle Name:CHRSITINE
Last Name:LONG
Suffix:
Gender:F
Credentials:STUDENT HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 BELLVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MC KEES ROCKS
Mailing Address - State:PA
Mailing Address - Zip Code:15136-1108
Mailing Address - Country:US
Mailing Address - Phone:703-244-0316
Mailing Address - Fax:
Practice Address - Street 1:3501 TERRACE ST
Practice Address - Street 2:UNIVERSITY OF PITTSBURGH
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2523
Practice Address - Country:US
Practice Address - Phone:412-647-8285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program