Individual
LAILA LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1687 MIDSUMMER NIGHT CV, FORT WAYNE, IN 46818-8467
(260) 446-4895
Mailing address
1687 MIDSUMMER NIGHT CV, FORT WAYNE, IN 46818-8467
(260) 446-4895
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/23/2025
Last updated
01/23/2025
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