Provider Demographics
NPI:1083379127
Name:LANGHAM, JENNIFER ANN (RN, ACNPC-AG)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:LANGHAM
Suffix:
Gender:F
Credentials:RN, ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 511360
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-7915
Mailing Address - Country:US
Mailing Address - Phone:775-398-1981
Mailing Address - Fax:775-398-1984
Practice Address - Street 1:6880 S MCCARRAN BLVD STE 5
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6129
Practice Address - Country:US
Practice Address - Phone:775-398-1981
Practice Address - Fax:775-398-1984
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV838434363LG0600X, 363LG0600X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology