Provider Demographics
NPI:1528643897
Name:LANGFORD, BRENDA LEE (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:LEE
Last Name:LANGFORD
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 220TH ST
Mailing Address - Street 2:
Mailing Address - City:SAUK VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60411-5010
Mailing Address - Country:US
Mailing Address - Phone:708-203-8216
Mailing Address - Fax:
Practice Address - Street 1:12757 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2155
Practice Address - Country:US
Practice Address - Phone:708-293-8437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209021014363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily