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Individual

MRS. GENA MARIE LONG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PMHNP

Contact information

Practice address
62 WILEY PL, BUFFALO, NY 14207-1644
(716) 238-1621
Mailing address
62 WILEY PL, BUFFALO, NY 14207-1644
(716) 238-1621

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F404718-01
NY

Other

Enumeration date
05/05/2023
Last updated
05/05/2023
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