Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 31866 | MN |
NPI | 1013980671 |
---|---|
Provider Name | Sherri A Long |
First Address | North Oaks, MN 55127-7848 |
Second Address | North Oaks, MN 55127-7848 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2006 |
Last Update Date | 11/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
974790700 | (05) | MN |
D98205 | (02) |