Individual
IVANA SHALONDA LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
890 W FARIS RD STE 470, GREENVILLE, SC 29605-4281
(864) 455-1600
(864) 455-3095
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
240441
SC
363LF0000X
Family Nurse Practitioner
Primary
27775
SC
Other
Enumeration date
07/27/2023
Last updated
02/25/2025
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