Individual
DANIEL LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1373 E STATE ROAD 62, MADISON, IN 47250-7328
(317) 783-7474
(317) 783-2283
Mailing address
34 AGIN WAY, MILTON, KY 40045-1509
(859) 979-2459
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
71004907A
IN
363LF0000X
Family Nurse Practitioner
Primary
71004907A
IN
Other
Enumeration date
04/24/2014
Last updated
06/21/2014
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