Healthcare Provider Details

I. General information

NPI: 1699188243
Provider Name (Legal Business Name): ANNA LANDEN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA LANGLEY

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 07/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DUMC 3458 2301 ERWIN DRIVE
DURHAM NC
27710-0001
US

IV. Provider business mailing address

DUMC 3458 2301 ERWIN DRIVE
DURHAM NC
27710-0001
US

V. Phone/Fax

Practice location:
  • Phone: 919-681-2425
  • Fax:
Mailing address:
  • Phone: 919-681-2425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0010-05011
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: