Individual
KATHY LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2803 W NEWMAN PKWY, PEORIA, IL 61604-2211
(309) 687-0053
Mailing address
2803 W NEWMAN PKWY, PEORIA, IL 61604-2211
(309) 687-0053
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043051028
IL
Other
Enumeration date
11/10/2016
Last updated
11/10/2016
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