Individual
LAURA L LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
8765 LEWIS AVENUE, TEMPERANCE, MI 48182
(734) 847-3802
Mailing address
408 DEERFIELD WOODS, LAMBERTVILLE, MI 48144
(734) 854-1356
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
RD86649
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
772703126
—
MI
Enumeration date
12/06/2006
Last updated
11/16/2012
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