Provider Demographics
NPI:1407912470
Name:LANGENDERFER, PAMELA SUE (NMD, MSOM, LAC)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:SUE
Last Name:LANGENDERFER
Suffix:
Gender:F
Credentials:NMD, MSOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2931
Mailing Address - Country:US
Mailing Address - Phone:208-758-0568
Mailing Address - Fax:833-810-1162
Practice Address - Street 1:518 N 4TH ST
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2931
Practice Address - Country:US
Practice Address - Phone:208-758-0568
Practice Address - Fax:833-810-1162
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDACU-148171100000X
WAAC60282929171100000X
IDNAT-4175F00000X
IDNMD-0020175F00000X
WANT-1257175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist