| NPI | 1992426555 |
|---|---|
| Former Name | MICHELLE LIANE LONGO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 279969) |
| Enumeration Date | 2022-09-12 |
| Last Update Date | 2022-09-12 |