Basic Information
Provider Information | |||||||||
NPI: | 1134108699 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LANGBEHN | ||||||||
FirstName: | JANE | ||||||||
MiddleName: | A | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | CNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | GLANZER | ||||||||
OtherFirstName: | JANE | ||||||||
OtherMiddleName: | A | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | CNP | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 2760 | ||||||||
Address2: |   | ||||||||
City: | RAPID CITY | ||||||||
State: | SD | ||||||||
PostalCode: | 577092760 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6053431333 | ||||||||
FaxNumber: | 6053436017 | ||||||||
Practice Location | |||||||||
Address1: | 2908 5TH ST | ||||||||
Address2: |   | ||||||||
City: | RAPID CITY | ||||||||
State: | SD | ||||||||
PostalCode: | 577017317 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6053431333 | ||||||||
FaxNumber: | 6053436017 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/12/2006 | ||||||||
LastUpdateDate: | 10/19/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | R024145 | SD | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
ID | Type | State | Issuer | Description | 6825150 | 05 | SD |   | MEDICAID | 4995992 | 01 | SD | WELLMARK NUMBER | OTHER | P00078798 | 01 | SD | RAILROAD MEDICARE | OTHER |