Individual
MARY JANE LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
MAMC 9040 JACKSON AVE, ATTN: MCHJ-CLQ-C, TACOMA, WA 98431-0001
(253) 224-3815
Mailing address
MAMC 9040 JACKSON AVE, ATTN: MCHJ-CLQ-C, TACOMA, WA 98431-0001
(253) 224-3815
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
60497344
WA
Other
Enumeration date
07/23/2016
Last updated
07/23/2016
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