Healthcare Provider Details

I. General information

NPI: 1063059426
Provider Name (Legal Business Name): MARY THERESA LANGMAID RN, MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 TOZER RD
BEVERLY MA
01915-5502
US

IV. Provider business mailing address

30 TOZER RD
BEVERLY MA
01915-5502
US

V. Phone/Fax

Practice location:
  • Phone: 978-745-3050
  • Fax: 978-745-7014
Mailing address:
  • Phone: 978-745-3050
  • Fax: 978-745-7014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN2295941
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN2295941
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2295941
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: