Individual
KYLA LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
611 E DOUGLAS RD STE 406, MISHAWAKA, IN 46545-1468
(574) 335-6514
Mailing address
54773 WINDING RIVER DR, MIDDLEBURY, IN 46540-9139
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/18/2024
Last updated
03/18/2024
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