Basic Information
| Provider Information | |||||||||
| NPI: | 1326318379 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LONG | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | GREGORY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RN, MSN, NNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2424 ERWIN RD | ||||||||
| Address2: | SUITE 504, NEONATOLOGY | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277053824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199706685 | ||||||||
| FaxNumber: | 9196816065 | ||||||||
| Practice Location | |||||||||
| Address1: | 5524 HOSPITAL N | ||||||||
| Address2: | BOX 100500 MEDICAL CENTER | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277100001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199706685 | ||||||||
| FaxNumber: | 9196816065 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2012 | ||||||||
| LastUpdateDate: | 01/09/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LN0000X | 5001550 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal |
No ID Information.