Provider Demographics
NPI:1316126980
Name:LANGDON, TIM S (RN)
Entity type:Individual
Prefix:
First Name:TIM
Middle Name:S
Last Name:LANGDON
Suffix:
Gender:M
Credentials:RN
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 875
Mailing Address - Street 2:
Mailing Address - City:TOK
Mailing Address - State:AK
Mailing Address - Zip Code:99780-0875
Mailing Address - Country:US
Mailing Address - Phone:907-738-8173
Mailing Address - Fax:
Practice Address - Street 1:MP 123 TOK CUTOFF
Practice Address - Street 2:UTHC
Practice Address - City:TOK
Practice Address - State:AK
Practice Address - Zip Code:99780-0129
Practice Address - Country:US
Practice Address - Phone:907-883-5185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK21966163WF0300X, 163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WF0300XNursing Service ProvidersRegistered NurseFlight