| NPI | 1477623015 |
|---|---|
| Former Name | SHELBA JEAN LONG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WV 38119) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WV 0274623) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2023-05-12 |