Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 147 | AZ |
NPI | 1114145000 |
---|---|
Provider Name | Mary Margaret Langlois |
First Address | Phoenix, AZ 85021-6817 |
Second Address | Phoenix, AZ 85021-6817 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 08/07/2007 |