Individual
JESSICA LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1042 WASHINGTON ST, RALEIGH, NC 27605-1258
(919) 781-4500
Mailing address
213 TILLAMOOK DR, WAKE FOREST, NC 27587-4935
(919) 841-8994
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
05/24/2022
Last updated
05/24/2022
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