Healthcare Provider Details

I. General information

NPI: 1851807663
Provider Name (Legal Business Name): MALI D LANGLIE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MALI D HUNT PA-C

II. Dates (important events)

Enumeration Date: 12/18/2017
Last Update Date: 12/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANDSTUHL REGIONAL MEDICAL CENTER OCCUPATIONAL HEALTH
APO AE
09180
US

IV. Provider business mailing address

LANDSTUHL REGIONAL MEDICAL CENTER ATTN: MCEUL-DCCS (CREDENTIALS), CMR 402
APO AE
09180
US

V. Phone/Fax

Practice location:
  • Phone: 11-496-3718
  • Fax: 11-496-3718
Mailing address:
  • Phone: 11-496-3718
  • Fax: 11-496-3718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number54928
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: