Individual
JOHNNA NICCO LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
101 GREENHORN AVE, EAGLE, CO 81631-6040
(970) 389-7353
Mailing address
PO BOX 181, EAGLE, CO 81631-0181
(970) 389-7353
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APN.0997169-NP
CO
Other
Enumeration date
12/02/2021
Last updated
12/02/2021
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