| NPI | 1770953861 |
|---|---|
| Former Name | MOLLY JEAN LONG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 019179) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA060497) |
| 363A00000X Physician Assistant (Licence: NY 19179) | |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2015-10-01 |
| Last Update Date | 2023-07-17 |