Individual
MS. GENEVIEVE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
1101 S MAIN ST, FORT WORTH, TX 76104-4802
(817) 321-4938
Mailing address
900 MEADOWVIEW DR, CROWLEY, TX 76036-3012
(817) 321-4938
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
103600
TX
Other
Enumeration date
12/20/2011
Last updated
12/20/2011
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