Healthcare Provider Details

I. General information

NPI: 1386122893
Provider Name (Legal Business Name): DANA E LANGHAM RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 04/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 WOOD ST
EUREKA CA
95501
US

IV. Provider business mailing address

14500 E 14TH ST UNIT 3368
SAN LEANDRO CA
94578-6916
US

V. Phone/Fax

Practice location:
  • Phone: 707-268-2990
  • Fax:
Mailing address:
  • Phone: 510-929-0970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number653783
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number653783
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: