Individual
COLETTE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1179 N MCDOWELL BLVD, PETALUMA, CA 94954-6559
(707) 559-7500
(707) 559-7620
Mailing address
1179 N MCDOWELL BLVD, PETALUMA, CA 94954-6559
(707) 559-7500
(707) 559-7620
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
95189488
CA
363L00000X
Nurse Practitioner
Primary
95012905
CA
Other
Enumeration date
09/17/2019
Last updated
12/29/2021
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