Individual
MRS. SANDRA KAY LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
VETERANS AFFAIRS MEDICAL CENTER, 2401 WEST MAIN, MARION, IL 62959
(618) 997-5311
Mailing address
216 PINEVIEW RD, CARBONDALE, IL 62901-5469
(618) 549-6756
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
—
IL
Other
Enumeration date
07/10/2006
Last updated
07/08/2007
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