Provider Demographics
NPI:1164785309
Name:LANGELOH, PAULA ANNE (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:ANNE
Last Name:LANGELOH
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1270 E STATE ROAD 205 STE 140
Practice Address - Street 2:
Practice Address - City:COLUMBIA CITY
Practice Address - State:IN
Practice Address - Zip Code:46725-8505
Practice Address - Country:US
Practice Address - Phone:260-248-9090
Practice Address - Fax:260-248-9095
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003989A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400073757OtherMEDICARE
IN201075610Medicaid