NPI | 1285609149 |
---|---|
Former Name | PATRICIA M LONG |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: IL 209-002885) |
Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: IL 209002885) |
Enumeration Date | 2006-02-22 |
Last Update Date | 2016-04-29 |