Individual
HEATHER MARIE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6654 BITTEROOT LN, BERKELEY, MO 63134-1451
(314) 395-5874
Mailing address
6654 BITTEROOT LN, BERKELEY, MO 63134-1451
Taxonomy
Speciality
Code
Description
License number
State
224900000X
Mastectomy Fitter
Primary
—
—
376J00000X
Homemaker
—
—
Other
Enumeration date
12/20/2019
Last updated
01/08/2022
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