Provider Demographics
NPI:1285392944
Name:LANGHAM, DEBORAH KAY (REGISTERED NURSE)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:KAY
Last Name:LANGHAM
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:KAY
Other - Last Name:LANGHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTER NURSE
Mailing Address - Street 1:205 N NORTH ST LOT 16
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:IL
Mailing Address - Zip Code:62560-5263
Mailing Address - Country:US
Mailing Address - Phone:618-699-9967
Mailing Address - Fax:
Practice Address - Street 1:205 N NORTH ST LOT 16
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:IL
Practice Address - Zip Code:62560-5263
Practice Address - Country:US
Practice Address - Phone:618-699-9967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041425537163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice