Individual
AMANDA LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
748 MCMECHEN ST, BENWOOD, WV 26031-1100
(304) 233-3747
Mailing address
411 S BROADWAY ST, WHEELING, WV 26003-2124
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1699896316
—
WV
Enumeration date
12/16/2020
Last updated
12/16/2020
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