Healthcare Provider Details

I. General information

NPI: 1740245810
Provider Name (Legal Business Name): CAROLYN LOUISE LANGDON N.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E WILLETTA ST RM. 3503
PHOENIX AZ
85006-2727
US

IV. Provider business mailing address

4323 W LAPENNA DR
PHOENIX AZ
85087-4905
US

V. Phone/Fax

Practice location:
  • Phone: 602-239-2635
  • Fax: 602-239-2307
Mailing address:
  • Phone: 623-518-9420
  • Fax: 623-518-9420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number17
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: