MEDICARE: MISS KATHERINE RAE LONG 374J00000X DOULA

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
1	374J00000X	Doula	NV20243188577	NV

General Provider Information

NPI Number	:	1497588214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KATHERINE RAE LONG 374J00000X DOULA

Provider Business Mailing Address
First Line	:	9755 SILVER SKY PKWY APT 307
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89506-2119
Country	:	US
Telephone Number	:	775-842-5848
Fax Number	:

Provider Business Practice Location Address
First Line	:	9755 SILVER SKY PKWY APT 307
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89506-2119
Country	:	US
Telephone Number	:	775-842-5848
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2024
Last Update Date	:	08/26/2024

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