NPI | 1104332543 |
---|---|
Former Name | BRANDY A LONG |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN274399) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 23506) |
Enumeration Date | 2017-12-21 |
Last Update Date | 2025-04-01 |