| NPI | 1356709315 |
|---|---|
| Former Name | ANDREA KAYE LONG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 24174589) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 340364) |
| Enumeration Date | 2016-02-05 |
| Last Update Date | 2020-04-15 |