MEDICARE: LAURA LANGEVIN PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN2303652	MA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN03406	RI
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2022008828	MA

General Provider Information

NPI Number	:	1023765930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA LANGEVIN PMHNP

Provider Business Mailing Address
First Line	:	45 INDUSTRIAL RD
Second Line	:
City	:	CUMBERLAND
State	:	RI
Zip	:	02864-4741
Country	:	US
Telephone Number	:	508-409-1467
Fax Number	:	949-404-8298

Provider Business Practice Location Address
First Line	:	45 INDUSTRIAL RD
Second Line	:
City	:	CUMBERLAND
State	:	RI
Zip	:	02864-4741
Country	:	US
Telephone Number	:	401-250-0123
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2022
Last Update Date	:	08/05/2024

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