Individual
MR. JEREMY LANGILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
321 MULBERRY ST SW, LENOIR, NC 28645-5720
(828) 757-5100
Mailing address
2101 HIGHWAY 90, GAUTIER, MS 39553-5340
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
312108
NC
367500000X
Certified Registered Nurse Anesthetist
R813945
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06279255
—
MS
01
—
47567560
TRICARE
—
01
—
640942692
BLUE CROSS OF MS
—
01
—
P00181476
RAILROAD MEDICARE
—
Enumeration date
02/27/2007
Last updated
08/16/2019
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