Provider Demographics
NPI:1376541276
Name:LANGFORD, OPHELIA OLBON (CRNA)
Entity Type:Individual
Prefix:
First Name:OPHELIA
Middle Name:OLBON
Last Name:LANGFORD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:OPHELIA
Other - Middle Name:
Other - Last Name:OLBON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 291264
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37229-1264
Mailing Address - Country:US
Mailing Address - Phone:615-620-2320
Mailing Address - Fax:615-620-2323
Practice Address - Street 1:726 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-4926
Practice Address - Country:US
Practice Address - Phone:615-653-9280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN10337367500000X
TNRN10337163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8051433Medicaid
TN4254555OtherBC/BC TN - DOUBLE O
TN1504257Medicaid
TN4232078OtherBC/BS OF TN - SO ANES CONSULTANTS
TN103I437177Medicare PIN