Individual
MS. KATHRYN LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
1055 MEDICAL PARK DR SE, GRAND RAPIDS, MI 49546-3607
(616) 942-9610
Mailing address
1055 MEDICAL PARK DR SE, GRAND RAPIDS, MI 49546-3607
(616) 942-9610
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
4704253154
MI
Other
Enumeration date
12/30/2019
Last updated
12/30/2019
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