Individual
LAURA ERIN LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8402 HARCOURT RD STE 420, INDIANAPOLIS, IN 46260-2053
(317) 415-6740
Mailing address
8402 HARCOURT RD STE 420, INDIANAPOLIS, IN 46260-2053
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10000583A
IN
363AS0400X
Surgical Physician Assistant
Primary
10000583A
IN
Other
Enumeration date
07/18/2005
Last updated
07/19/2022
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