Individual
JEANNIE LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1095 NICKERSON ST, WAYNOKA, OK 73860-1252
(580) 824-0674
Mailing address
PO BOX 135, WAYNOKA, OK 73860-0135
(580) 824-0676
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
08/30/2018
Last updated
08/30/2018
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