Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 124466 | CO |
NPI | 1093834145 |
---|---|
Provider Name | Mrs. Nicole Ann Long |
First Address | Commerce City, CO 80022-9542 |
Second Address | Parker, CO 80138-8575 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 08/07/2007 |