Provider Demographics
NPI:1114923802
Name:LANGFORD, MARY ELLEN (CRNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELLEN
Last Name:LANGFORD
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Gender:F
Credentials:CRNP
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Mailing Address - Street 1:600 S BROAD ST
Mailing Address - Street 2:GENESIS PHYSICIAN SERVICES
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-3346
Mailing Address - Country:US
Mailing Address - Phone:215-738-1184
Mailing Address - Fax:610-335-4486
Practice Address - Street 1:240 BARKER RD
Practice Address - Street 2:GENESIS PHYSICIAN SERVICES
Practice Address - City:WYNCOTE
Practice Address - State:PA
Practice Address - Zip Code:19095-1716
Practice Address - Country:US
Practice Address - Phone:215-738-1184
Practice Address - Fax:610-335-4486
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2015-08-10
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Provider Licenses
StateLicense IDTaxonomies
PASP003967H363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA014748Medicare PIN