Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1346803509 |
---|---|
Provider Name | Felicia Nicole Long |
First Address | Charlotte, NC 28277-1678 |
Second Address | Charlotte, NC 28217-1808 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2019 |
Last Update Date | 15/04/2019 |