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NPI Code Detail

MEDICARE: JONDRA DIANNE LONG MS, BSN, RN

MEDICARE: JONDRA DIANNE LONG MS, BSN, RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse254692OH

General Provider Information

NPI Number : 1073112553
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONDRA DIANNE LONG MS, BSN, RN
Provider Business Mailing Address
First Line : 8105 TIMBERTREE WAY
Second Line :
City : WEST CHESTER
State : OH
Zip : 45069-1605
Country : US
Telephone Number : 937-776-2685
Fax Number :
Provider Business Practice Location Address
First Line : 3800 VICTORY PKWY UNIT 1
Second Line :
City : CINCINNATI
State : OH
Zip : 45207-1092
Country : US
Telephone Number : 513-745-3802
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2020
Last Update Date : 10/26/2020

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