MEDICARE: JUNE LONG NP-C

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	363LF0000X	Family Nurse Practitioner	71006449A	IN

General Provider Information

NPI Number	:	1518412832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUNE LONG NP-C

Provider Business Mailing Address
First Line	:	6019 EPPERSON DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46221-4607
Country	:	US
Telephone Number	:	317-850-1332
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 FIELDS ST
Second Line	:
City	:	MOORESVILLE
State	:	IN
Zip	:	46158
Country	:	US
Telephone Number	:	317-497-2193
Fax Number	:

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

Provider Enumeration Date	:	08/16/2016
Last Update Date	:	11/27/2023

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