Individual
KATHLEEN A LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-BC, ND
Contact information
Practice address
420 W 4TH ST, MISHAWAKA, IN 46544-1948
(574) 307-7673
(574) 307-7692
Mailing address
420 W 4TH ST, MISHAWAKA, IN 46544-1948
(574) 307-7673
(574) 307-7692
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71001562A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000878026
BCBS
IN
05
—
200441170
—
IN
Enumeration date
07/27/2006
Last updated
01/17/2019
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