Individual
STEPHANIE LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2626 E 46TH ST, STE J, INDIANAPOLIS, IN 46205-2380
(317) 475-9066
Mailing address
726 E GIMBER ST, INDIANAPOLIS, IN 46203-5121
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
27068594A
IN
Other
Enumeration date
08/30/2012
Last updated
08/30/2012
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