Provider Demographics
NPI:1114145000
Name:LANGLOIS, MARY MARGARET (LM)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MARGARET
Last Name:LANGLOIS
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2332 W VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-6817
Mailing Address - Country:US
Mailing Address - Phone:602-672-1318
Mailing Address - Fax:602-242-3009
Practice Address - Street 1:2332 W VISTA AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-6817
Practice Address - Country:US
Practice Address - Phone:602-672-1318
Practice Address - Fax:602-242-3009
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ147176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife