Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 13412 | CO |
NPI | 1518152842 |
---|---|
Provider Name | Dr. Samuel Husbands Langstaff JR. |
First Address | Denver, CO 80262 |
Second Address | Sheridan, CO 80110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2007 |
Last Update Date | 10/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01134121 | (05) | CO |
P04780 | (02) | CO |