Provider Demographics
NPI:1356742134
Name:EVANS-LANGHORST, MARGARET BLAIR (NP)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:BLAIR
Last Name:EVANS-LANGHORST
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:BLAIR
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:6 SOUTH
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:857-218-4974
Mailing Address - Fax:
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:6 SOUTH
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:857-218-4974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2277517363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics