Provider Demographics
NPI:1821688714
Name:LONG, KYLIE ANN (RN)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:ANN
Last Name:LONG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Mailing Address - Street 1:100 POWELL DR STE 1
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:MI
Mailing Address - Zip Code:48131-8645
Mailing Address - Country:US
Mailing Address - Phone:517-266-1481
Mailing Address - Fax:517-266-1530
Practice Address - Street 1:100 POWELL DR STE 1
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:MI
Practice Address - Zip Code:48131-8645
Practice Address - Country:US
Practice Address - Phone:517-266-1481
Practice Address - Fax:517-266-1530
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704285821163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health