Individual
TRACEY LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10512 BRENTWOOD DR, LA VISTA, NE 68128-5775
(402) 619-6482
Mailing address
10512 BRENTWOOD DR, LA VISTA, NE 68128-5775
(402) 619-6482
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
02/03/2025
Last updated
02/03/2025
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