| NPI | 1265910269 |
|---|---|
| Former Name | LARA MADISON LONG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OK 103047) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OK R103047) |
| Enumeration Date | 2018-08-01 |
| Last Update Date | 2023-03-17 |