Individual
JONILLA DEANE LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1095 NICKERSON ST, WAYNOKA, OK 73860-1252
(580) 824-0674
Mailing address
1929 SANTA FE ST, WAYNOKA, OK 73860-3905
(580) 737-0323
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
23592
OK
Other
Enumeration date
08/21/2012
Last updated
08/21/2012
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