Provider Demographics
NPI:1184921314
Name:LANGUM, LESLIE ANN (PA-C)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:LANGUM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8338 ROVENNA ST
Mailing Address - Street 2:#B
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-2914
Mailing Address - Country:US
Mailing Address - Phone:712-420-1187
Mailing Address - Fax:
Practice Address - Street 1:4100 LAKE OTIS PKWY
Practice Address - Street 2:SUITE 322
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5229
Practice Address - Country:US
Practice Address - Phone:907-562-1234
Practice Address - Fax:907-561-8550
Is Sole Proprietor?:No
Enumeration Date:2011-02-24
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2315363A00000X
SD363A00000X
AK1163363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant