Healthcare Provider Details

I. General information

NPI: 1699449587
Provider Name (Legal Business Name): JOSEPH ANTHONY LANGOWSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 OLD TUNNEL RD
GRASS VALLEY CA
95945-8524
US

IV. Provider business mailing address

844 OLD TUNNEL RD
GRASS VALLEY CA
95945-8524
US

V. Phone/Fax

Practice location:
  • Phone: 530-274-9762
  • Fax:
Mailing address:
  • Phone: 530-274-9762
  • Fax: 530-273-7255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95166093
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95018051
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: