MEDICARE: MS. CAROLYN LOUISE LANGDON N.N.P.

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	363LN0005X	Critical Care Neonatal Nurse Practitioner	17	AZ

General Provider Information

NPI Number	:	1740245810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROLYN LOUISE LANGDON N.N.P.

Provider Business Mailing Address
First Line	:	4323 W LAPENNA DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85087-4905
Country	:	US
Telephone Number	:	623-518-9420
Fax Number	:	623-518-9420

Provider Business Practice Location Address
First Line	:	901 E WILLETTA ST
Second Line	:	RM. 3503
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2727
Country	:	US
Telephone Number	:	602-239-2635
Fax Number	:	602-239-2307

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	07/08/2007

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