MEDICARE: GWENDOLYN ELAINE LONG

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	347C00000X	Private Vehicle
2	376J00000X	Homemaker

General Provider Information

NPI Number	:	1831879923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWENDOLYN ELAINE LONG

Provider Business Mailing Address
First Line	:	710 STATE ROUTE 555 NE
Second Line	:
City	:	CORNING
State	:	OH
Zip	:	43730-9782
Country	:	US
Telephone Number	:	740-342-9032
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 STATE ROUTE 555 NE
Second Line	:
City	:	CORNING
State	:	OH
Zip	:	43730-9782
Country	:	US
Telephone Number	:	614-843-0050
Fax Number	:

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

Provider Enumeration Date	:	07/24/2023
Last Update Date	:	07/24/2023

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Directions to “ GWENDOLYN ELAINE LONG ” Practice Location

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