Provider Demographics
NPI:1154563070
Name:LANGDET, LETICIA
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:LANGDET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 IRVING AVE
Mailing Address - Street 2:APT 2-B
Mailing Address - City:WYANDANCH
Mailing Address - State:NY
Mailing Address - Zip Code:11798-3417
Mailing Address - Country:US
Mailing Address - Phone:347-898-8168
Mailing Address - Fax:
Practice Address - Street 1:1 IRVING AVENUE
Practice Address - Street 2:APT 2-B
Practice Address - City:WYANDANCH
Practice Address - State:NY
Practice Address - Zip Code:11798
Practice Address - Country:US
Practice Address - Phone:347-898-8168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY609558163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse