Individual
JACQUELINE L LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3901 RAINBOW BLVD, KANSAS CITY, KS 66160-8500
(913) 588-5000
Mailing address
PO BOX 411851, KANSAS CITY, MO 64141-1851
(913) 588-5000
(913) 588-5000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
55022
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100417780A
—
KS
Enumeration date
10/05/2006
Last updated
07/25/2014
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