Individual
MRS. JACQUELINE A. LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
311 WEST FAIRCHILD STREET, DANVILLE, IL 61837-3876
(217) 431-7700
(217) 431-7850
Mailing address
611 W. PARK ST., BWPC, URBANA, IL 61801-2500
(217) 383-6792
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209009428
IL
Other
Enumeration date
03/07/2012
Last updated
01/23/2015
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