Healthcare Provider Details

I. General information

NPI: 1033711908
Provider Name (Legal Business Name): CHRISTINE M LANGSTON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2020
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13640 N PLAZA DEL RIO BLVD
PEORIA AZ
85381-4846
US

IV. Provider business mailing address

1300 N 12TH ST STE 610
PHOENIX AZ
85006-2850
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-3800
  • Fax:
Mailing address:
  • Phone: 602-839-4456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number063835
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: