Most Relevant Information
Provider Data
| NPI Number: | 1003553637 |
| Provider Name: | SUSIE JANE LONG |
| Entity Type: | Individual |
| Taxonomy Code: | 3747P1801X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/16/2022 |
| Last Updated: | 05/16/2022 |
Provider Practice Location
16 MOUNTAIN PARK DR
FAIRMONT
WV
265548992
Practice Location Phone/Fax
| Phone: | 3048163687 |
| Fax: | 3048163737 |
Provider Mailing Location
16 MOUNTAIN PARK DR
FAIRMONT
WV
265548992
Provider Mailing Phone/Fax
| Phone: | 3048163687 |
| Fax: | 3048163737 |