Individual
MRS. CAROL JEAN LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
18404 51ST AVE, CHIPPEWA FALLS, WI 54729-6839
(715) 720-7794
Mailing address
18404 51ST AVE, CHIPPEWA FALLS, WI 54729-6839
(715) 720-7794
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
17504-31
WI
Other
Enumeration date
01/20/2016
Last updated
01/20/2016
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