Provider Demographics
NPI:1861743486
Name:LONG, LOVETTA B (CNA)
Entity type:Individual
Prefix:MRS
First Name:LOVETTA
Middle Name:B
Last Name:LONG
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 AL HIGHWAY 60
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:AL
Mailing Address - Zip Code:35441-2603
Mailing Address - Country:US
Mailing Address - Phone:334-507-2368
Mailing Address - Fax:205-372-2723
Practice Address - Street 1:633 AL HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:AL
Practice Address - Zip Code:35441-2603
Practice Address - Country:US
Practice Address - Phone:334-507-2368
Practice Address - Fax:205-372-2723
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide