Provider Demographics
NPI:1952578684
Name:LANGLEY, KATINA LASHUN (RD)
Entity Type:Individual
Prefix:MRS
First Name:KATINA
Middle Name:LASHUN
Last Name:LANGLEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14097 W WINDWARD AVE
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2050
Mailing Address - Country:US
Mailing Address - Phone:623-536-5718
Mailing Address - Fax:
Practice Address - Street 1:14097 W WINDWARD AVE
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2050
Practice Address - Country:US
Practice Address - Phone:623-536-5718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002061133VN1004X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered