Provider Demographics
NPI:1992513634
Name:DELONG, JOLENE MICHELLE
Entity type:Individual
Prefix:
First Name:JOLENE
Middle Name:MICHELLE
Last Name:DELONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:MC COOL JUNCTION
Mailing Address - State:NE
Mailing Address - Zip Code:68401-0326
Mailing Address - Country:US
Mailing Address - Phone:402-710-2797
Mailing Address - Fax:
Practice Address - Street 1:236 N 3RD AVE
Practice Address - Street 2:PO BOX 326
Practice Address - City:MCCOOL JUNCTION
Practice Address - State:NE
Practice Address - Zip Code:68401-0326
Practice Address - Country:US
Practice Address - Phone:402-710-2797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor