| NPI | 1538541768 |
|---|---|
| Former Name | KATIE KIMBERLY LONGO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME136447) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125-066188) |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2022-08-21 |