Provider Demographics
NPI:1144797135
Name:LANGFORD, ERIN ALEISHA (FNP-C)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:ALEISHA
Last Name:LANGFORD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4624 EASTERN AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-4408
Mailing Address - Country:US
Mailing Address - Phone:505-980-8866
Mailing Address - Fax:
Practice Address - Street 1:4588 PARADISE BLVD NW # 100
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-4105
Practice Address - Country:US
Practice Address - Phone:505-998-1717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-28
Last Update Date:2018-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM54352207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM54352OtherNEW MEXICO STATE BOARD OF NURSING