Individual
TRACY DINAH LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2629 W I 44 SERVICE RD STE 202, OKLAHOMA CITY, OK 73112-3762
(405) 605-1865
Mailing address
2120 SW 84TH ST, OKLAHOMA CITY, OK 73159-6102
(405) 505-6205
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
37V239421202
OK
Other
Enumeration date
06/18/2017
Last updated
06/18/2017
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