Heather Marie Long

Individual provider Active NPI Mastectomy Fitter · Berkeley, MO

NPI 1659919611 · NPPES record last updated Jan 8, 2022

Key facts

NPI
1659919611
Entity type
Individual (NPI type 1)
Primary specialty
Mastectomy Fitter 224900000X
Practice address
6654 Bitteroot LN
Berkeley, MO 63134-1451
Phone
(314) 395-5874
NPI assigned
Dec 20, 2019
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Homemaker 376J00000X
Mastectomy Fitter 224900000X Yes

Addresses

Primary practice location

6654 Bitteroot LN
Berkeley, MO 63134-1451

Mailing address

6654 Bitteroot LN
Berkeley, MO 63134-1451

Other providers in Berkeley, MO

All providers in Berkeley, MO · Mastectomy Fitter in Missouri

Sources for this page

Verify at the official NPI Registry.