Most Relevant Information
Provider Data
| NPI Number: | 1003531153 |
| Provider Name: | STEPHANIE RENEE LONG FNP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 5017021 |
Most Important Dates
| Enumeration Date: | 10/10/2022 |
| Last Updated: | 10/10/2022 |
Provider Practice Location
55 BUCKEYE COVE RD
CANTON
NC
287164511
Practice Location Phone/Fax
| Phone: | 8285648028 |
| Fax: |
Provider Mailing Location
55 BUCKEYE COVE RD
CANTON
NC
287164511
Provider Mailing Phone/Fax
| Phone: | 8285648028 |
| Fax: |