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Individual

MRS. SHANNON FRESHWATER LONG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
6900 ALDEN DR, FE WARREN AFB, WY 82005-2945
(307) 773-3435
Mailing address
UNIT 3215, APO, AE 09094-3215
(314) 479-2049

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1588111090
NPI
Enumeration date
09/01/2016
Last updated
10/26/2022
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