Healthcare Provider Details

I. General information

NPI: 1376541276
Provider Name (Legal Business Name): OPHELIA OLBON LANGFORD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OPHELIA OLBON CRNA

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 07/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 S CHURCH ST
MURFREESBORO TN
37130-4926
US

IV. Provider business mailing address

PO BOX 291264
NASHVILLE TN
37229-1264
US

V. Phone/Fax

Practice location:
  • Phone: 615-653-9280
  • Fax:
Mailing address:
  • Phone: 615-620-2320
  • Fax: 615-620-2323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN10337
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN10337
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: