Healthcare Provider Details

I. General information

NPI: 1932576790
Provider Name (Legal Business Name): PAULA LANGELOH, APRN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2015
Last Update Date: 08/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 N OPPORTUNITY DR
COLUMBIA CITY IN
46725-1041
US

IV. Provider business mailing address

3256 W CIRCLE DR
COLUMBIA CITY IN
46725-9181
US

V. Phone/Fax

Practice location:
  • Phone: 260-609-3576
  • Fax:
Mailing address:
  • Phone: 260-609-3576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71003989A
License Number StateIN

VIII. Authorized Official

Name: PAULA A LANGELOH
Title or Position: OWNER
Credential: FNP-C
Phone: 260-609-3576