Provider Demographics
NPI:1053947176
Name:LANGLOIS, AUDRA (PAC)
Entity type:Individual
Prefix:MS
First Name:AUDRA
Middle Name:
Last Name:LANGLOIS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5665 W SANDALWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-5996
Mailing Address - Country:US
Mailing Address - Phone:231-798-8070
Mailing Address - Fax:
Practice Address - Street 1:1675 LEAHY ST STE 401
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5544
Practice Address - Country:US
Practice Address - Phone:231-728-4243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant