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Individual

MICHELLE DAWN LONG

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
1 MEDICAL VILLAGE DR, EDGEWOOD, KY 41017-3403
(859) 301-2237
(859) 301-3962
Mailing address
PO BOX 636324, CINCINNATI, OH 45263-6324
(859) 301-2237
(859) 301-3962

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1092014
KY
363L00000X
Nurse Practitioner
Primary
3005068
KY
363LA2200X
Adult Health Nurse Practitioner
3005068
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2852506
OH
05
7100041660
KY
Enumeration date
05/30/2007
Last updated
10/29/2019
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