Most Relevant Information
Provider Data
| NPI Number: | 1003456609 |
| Provider Name: | WANDA K. LONG ACNP-BC |
| Entity Type: | Individual |
| Taxonomy Code: | 363LA2100X |
| Specialty: | Nurse Practitioner |
| License Number: | 95013493 |
Most Important Dates
| Enumeration Date: | 01/10/2020 |
| Last Updated: | 01/10/2020 |
Provider Practice Location
40891 BREEZY PASS RD
PALM DESERT
CA
922117263
Practice Location Phone/Fax
| Phone: | 7577140916 |
| Fax: |
Provider Mailing Location
40891 BREEZY PASS RD
PALM DESERT
CA
922117263
Provider Mailing Phone/Fax
| Phone: | 7577140916 |
| Fax: |