Provider Demographics
NPI:1871993147
Name:LANGLEY, CARRIE LYNN (FNP BC)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:LYNN
Last Name:LANGLEY
Suffix:
Gender:F
Credentials:FNP BC
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:LYNN
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1409 MIDLAND RD
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-9474
Mailing Address - Country:US
Mailing Address - Phone:989-214-0153
Mailing Address - Fax:989-269-7490
Practice Address - Street 1:1142 S VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-9800
Practice Address - Country:US
Practice Address - Phone:989-269-7445
Practice Address - Fax:989-269-7490
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-24
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704208018363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily