Provider Demographics
NPI:1174903785
Name:LANGER, BEVERLEY LYNN (LPN)
Entity type:Individual
Prefix:MRS
First Name:BEVERLEY
Middle Name:LYNN
Last Name:LANGER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1069 E REID RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8905
Mailing Address - Country:US
Mailing Address - Phone:810-953-0627
Mailing Address - Fax:
Practice Address - Street 1:1069 E REID RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8905
Practice Address - Country:US
Practice Address - Phone:810-953-0627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703114971164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse