Individual
MRS. BEVERLY JEAN LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA, MS
Contact information
Practice address
678 E ELM ST, REPUBLIC, MO 65738-1500
(417) 732-6894
Mailing address
678 E ELM ST, REPUBLIC, MO 65738-1500
(417) 732-6894
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
0024166617
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
122344
MO
367500000X
Certified Registered Nurse Anesthetist
172980 (APN 4715)
CO
367500000X
Certified Registered Nurse Anesthetist
51993
ME
Other
Enumeration date
07/03/2006
Last updated
07/08/2007
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