| NPI | 1609274760 |
|---|---|
| Former Name | JENNIFER M LONG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IA A132335) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209012267) |
| Enumeration Date | 2014-12-05 |
| Last Update Date | 2017-11-29 |