| NPI | 1528205119 |
|---|---|
| Former Name | ALICIA SUE LONGE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 1461) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 4368) |
| Enumeration Date | 2009-01-19 |
| Last Update Date | 2022-07-21 |