Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 20030004 | TX |
NPI | 1063041242 |
---|---|
Provider Name | Victoria Long |
First Address | Burnet, TX 78611-6289 |
Second Address | Burnet, TX 78611-6289 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2020 |
Last Update Date | 08/04/2020 |