Provider Demographics
NPI:1144208521
Name:LANGELIERS, JEAN (LRD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:LANGELIERS
Suffix:
Gender:F
Credentials:LRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 841
Mailing Address - Street 2:
Mailing Address - City:BEULAH
Mailing Address - State:ND
Mailing Address - Zip Code:58523-0841
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1312 HWY 49 NW
Practice Address - Street 2:
Practice Address - City:BEULAH
Practice Address - State:ND
Practice Address - Zip Code:58523
Practice Address - Country:US
Practice Address - Phone:701-873-4445
Practice Address - Fax:701-873-4199
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND173133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND55068Medicaid
ND25694Medicare ID - Type Unspecified