| Doctor Name: | LISA M LONG |
| NPI Number: | 1396807939 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 201617 |
| Business Practice Address: | 584 Hospital Dr Ne Suite A Bolivia, NC - 284229047 |
| Business Phone Number: | 9107214000 |
| Business Fax Number: | 9107214001 |
| Mailing Address: | 1606 Physicians Dr, Ste 102 WILMINGTON |
| State: | NC |
| Postal Code: | 284017348 |
| Phone Number: | 9107214000 |
| Fax Number: | |
| NPI Enumeration Date: | 12/13/2006 |
| NPI Last Update Date: | 03/11/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 201617 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |