Individual
MADONNA ELIZABETH MARIE LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
806 PINE AVE, KEMMERER, WY 83101-2900
(307) 877-2993
Mailing address
PO BOX 1074, KEMMERER, WY 83101-1074
(307) 877-2993
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
02/04/2021
Last updated
02/04/2021
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