| NPI | 1073380218 |
|---|---|
| Former Name | JENNIFER GAYLE LONG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: IN 71014884A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28212115A) |
| Enumeration Date | 2023-12-07 |
| Last Update Date | 2024-02-05 |