Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 30909 | MN |
N | 208600000X | Surgeon | 30909 | MN |
Y | 208200000X | Surgeon | 69634 | MN |
Y | 208600000X | Surgeon | 69634 | MN |
NPI | 1013452978 |
---|---|
Provider Name | Jane Long |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905-0005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2017 |
Last Update Date | 31/08/2021 |