Provider Demographics
NPI:1174680813
Name:LANGDON, JILL MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:LANGDON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-1405
Mailing Address - Country:US
Mailing Address - Phone:253-572-9160
Mailing Address - Fax:206-572-3862
Practice Address - Street 1:325 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2420
Practice Address - Country:US
Practice Address - Phone:206-731-8374
Practice Address - Fax:206-731-4151
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30001462363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9606302Medicaid
WAAP30001462OtherARNP LICENSE NUMBER
WAAP30001462OtherARNP LICENSE NUMBER
WA9606302Medicaid