Provider Demographics
NPI:1568471951
Name:LANGSLET, TERESA C (PA-C)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:C
Last Name:LANGSLET
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-4561
Mailing Address - Country:US
Mailing Address - Phone:530-257-7335
Mailing Address - Fax:530-257-9735
Practice Address - Street 1:1810 1ST ST
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-4561
Practice Address - Country:US
Practice Address - Phone:530-257-7335
Practice Address - Fax:530-257-9735
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15986363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ42576ZOtherBLUE SHIELD DFP
CAZZZ95961ZOtherBLUE SHIELD WFP
CAFHC03843FMedicaid
CAFHC70292FMedicaid
ZZZ87615ZOtherBLUE SHIELD NHC
CAFHC70081FMedicaid
CAFHC03843FMedicaid
051947Medicare ID - Type UnspecifiedDFP
CAFHC70292FMedicaid
CAFHC70081FMedicaid