Individual
MS. MADELINE VICTORIA LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3001 BROADMOOR BLVD NE, RIO RANCHO, NM 87144-2100
(505) 994-7000
Mailing address
800 BRADBURY DR SE STE 116, ALBUQUERQUE, NM 87106-4310
(505) 272-1476
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2018-0067
NM
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
08/20/2018
Last updated
09/11/2024
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