Telisa Long

NPI 1285866111 - Private Vehicle - 347C00000X

NPI Details
NPI 1285866111
Gender Female
Enumeration Date 08/11/2009
Last Updated 08/11/2009
Entity Type Individual
Active Over 7 years ago
Practice Location
413 INDIANWOOD BLVD
PARK FOREST IL, 60466-2247, US
Phone (708) 369-2368
Fax (708) 747-5980
Business Location
413 INDIANWOOD BLVD
PARK FOREST IL, 60466-2247, US
Phone (708) 369-2368
Fax (708) 747-5980
Toxanomy
Taxonomy Code 347C00000X
License State Illinois
License Number L52081680690
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According to our database, Ms. Telisa Long NPI is 1285866111, taxonomy code is 347C00000X and license number is L52081680690, license state is located at Illinois. Telisa Long physically located at 413 Indianwood Blvd, Park Forest IL, 60466-2247. NPI Number Telisa Long has the Individual type.

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1285866111 NPI number is provided on an as is basis without warranty of any kind. 1285866111 is maintained by the National Plan & Provider Enumeration System. The contents of Telisa Long are for informational purposes only.