| NPI | 1770161101 |
|---|---|
| Former Name | JAIMIE ELIZABETH LONG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX V0028) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2021-03-29 |
| Last Update Date | 2026-07-26 |