Healthcare Provider Details

I. General information

NPI: 1649291881
Provider Name (Legal Business Name): SARAH LANGWELL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 08/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 THE 25 WAY NE SUITE 150
ALBUQUERQUE NM
87109-5857
US

IV. Provider business mailing address

4411 THE 25 WAY NE SUITE 150
ALBUQUERQUE NM
87109-5857
US

V. Phone/Fax

Practice location:
  • Phone: 505-332-6919
  • Fax: 505-332-6921
Mailing address:
  • Phone: 505-332-6919
  • Fax: 505-332-6921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA2002-0025
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2002-0025
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: