Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | 5101020941 | MI |
Y | 2084N0400X | Neurologist | 70781-21 | WI |
NPI | 1033523329 |
---|---|
Provider Name | Daniel Long |
First Address | Neenah, WI 54956-1993 |
Second Address | Neenah, WI 54956-1993 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2014 |
Last Update Date | 25/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100088599 | (05) | WI |