1497732309 NPI number — LYNN MARIE LANGSFORD ARNP CNM

Table of content: LYNN MARIE LANGSFORD ARNP CNM (NPI 1497732309)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497732309 NPI number — LYNN MARIE LANGSFORD ARNP CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANGSFORD
Provider First Name:
LYNN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497732309
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6002 N WESTGATE BLVD
Provider Second Line Business Mailing Address:
STE 230
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-761-2244
Provider Business Mailing Address Fax Number:
253-761-1040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6002 N WESTGATE BLVD
Provider Second Line Business Practice Location Address:
STE 230
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-761-2244
Provider Business Practice Location Address Fax Number:
253-761-1040
Provider Enumeration Date:
12/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN00074183 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LX0001X , with the licence number: 025804 AP30001892 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367A00000X , with the licence number: 025804 AP30001892 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9613431 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0270558 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: G8896179 . This is a "MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: LA7596 . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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