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: |