Provider Demographics
NPI:1649291121
Name:LONG, JANET BOWEN (MSN, ACNP)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:BOWEN
Last Name:LONG
Suffix:
Gender:F
Credentials:MSN, ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 VETERANS MEMORIAL PARKWAY
Mailing Address - Street 2:#15
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914
Mailing Address - Country:US
Mailing Address - Phone:401-228-2020
Mailing Address - Fax:401-228-2026
Practice Address - Street 1:450 VETERANS MEMORIAL PARKWAY
Practice Address - Street 2:#15
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914
Practice Address - Country:US
Practice Address - Phone:401-228-2020
Practice Address - Fax:401-228-2026
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP16167363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIJL28613Medicaid
RI007056762Medicare ID - Type Unspecified
RIJL28613Medicaid