MRS. Shannon Freshwater Long, PA-C

NPI #1588111090 in Fe Warren Afb, Wyoming

Provider Information

NPI Number: 1588111090
Entity Type: Individual
Name: MRS. Shannon Freshwater Long, PA-C
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physician Assistant
Credential: PA-C
Enumeration Date: Sep 1, 2016
Last Updated: Oct 26, 2022

Practice Location

Address: 6900 ALDEN DR
City: Fe Warren Afb
State: Wyoming
ZIP Code: 82005-2945
Phone: (307) 773-3435

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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