Individual
KELLY A LONGSTREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
USCGC FIR (WLB 213) BASE TONGUE POINT, ASTORIA, OR 97103
(503) 325-1601
Mailing address
2 EBB TIDE LNDG, POQUOSON, VA 23662-1334
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
02/20/2007
Last updated
07/08/2007
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