Provider Demographics
NPI:1194168930
Name:LANGFORD, MARLENA (APN-BC)
Entity type:Individual
Prefix:MRS
First Name:MARLENA
Middle Name:
Last Name:LANGFORD
Suffix:
Gender:F
Credentials:APN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21890
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4115
Mailing Address - Country:US
Mailing Address - Phone:502-907-0356
Mailing Address - Fax:502-919-9780
Practice Address - Street 1:700 KIMBER LANE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-2803
Practice Address - Country:US
Practice Address - Phone:812-476-7111
Practice Address - Fax:812-476-7117
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008284363LA2200X
IN71004454A363LA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
8059404OtherCIGNA
8703700OtherAETNA PIN
IN201178460Medicaid
000001083038OtherANTHEM PIN
KY1530528OtherWELLCARE OF KY PROVIDER ID NUMBER
KY7100290800Medicaid
CS1807800105OtherCARESOURCE ID
3688482OtherUNITED HEALTHCARE PROVIDER ID NUMBER