Healthcare Provider Details

I. General information

NPI: 1982240842
Provider Name (Legal Business Name): JILL MARIE LANGHALS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41201 SCHADDEN RD
ELYRIA OH
44035-2249
US

IV. Provider business mailing address

41201 SCHADDEN RD
ELYRIA OH
44035-2249
US

V. Phone/Fax

Practice location:
  • Phone: 440-222-4003
  • Fax: 440-960-9222
Mailing address:
  • Phone: 440-222-4003
  • Fax: 440-960-9222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.025900
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.025900
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: