Individual
MOLLY CATHERINE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
3512 STELLHORN RD, FORT WAYNE, IN 46815-4631
(260) 483-9081
(260) 483-9196
Mailing address
PO BOX 392552, PITTSBURGH, PA 15251-9552
(260) 483-9081
(260) 436-9662
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28192221A
IN
363LA2200X
Adult Health Nurse Practitioner
Primary
71005386A
IN
Other
Enumeration date
03/12/2015
Last updated
12/06/2018
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