| NPI | 1215773585 |
|---|---|
| Former Name | BETHANY MARIE LONG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 376J00000X Homemaker |
| Additional Taxonomies | 172A00000X Driver (Licence: OH Sv455422) |
| Enumeration Date | 2024-07-05 |
| Last Update Date | 2024-07-05 |