Most Relevant Information
Provider Data
| NPI Number: | 1003563925 |
| Provider Name: | KACI LONGTIN |
| Entity Type: | Individual |
| Taxonomy Code: | 174400000X |
| Specialty: | Specialist |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/10/2022 |
| Last Updated: | 03/10/2022 |
Provider Practice Location
1547 30TH AVE S
MOORHEAD
MN
565605149
Practice Location Phone/Fax
| Phone: | 2182874338 |
| Fax: | 2182875928 |
Provider Mailing Location
1547 30TH AVE S
MOORHEAD
MN
565605149
Provider Mailing Phone/Fax
| Phone: | 2182874338 |
| Fax: | 2182875928 |