Most Relevant Information
Provider Data
| NPI Number: | 1003553066 |
| Provider Name: | TARA LONG |
| Entity Type: | Individual |
| Taxonomy Code: | 164W00000X |
| Specialty: | Licensed Practical Nurse |
| License Number: | 163360 |
Most Important Dates
| Enumeration Date: | 05/19/2022 |
| Last Updated: | 05/19/2022 |
Provider Practice Location
17273 STATE ROUTE 104
CHILLICOTHE
OH
456019718
Practice Location Phone/Fax
| Phone: | 7407731141 |
| Fax: |
Provider Mailing Location
17273 STATE ROUTE 104
CHILLICOTHE
OH
456019718
Provider Mailing Phone/Fax
| Phone: | 7407731141 |
| Fax: |