Individual
MS. JEANETTE LONG X
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
70 ALEXANDER ST, ELDORADO, IL 62930
(618) 841-0074
Mailing address
PO BOX 218, ELIZABETHTWON, IL 62931
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043072196
IL
Other
Enumeration date
06/07/2017
Last updated
06/07/2017
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