Provider Demographics
NPI:1770063190
Name:LANGBECKER, GINA RACHELLE (LVN)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:RACHELLE
Last Name:LANGBECKER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MS
Other - First Name:GINA
Other - Middle Name:RACHELLE
Other - Last Name:BOHANAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:371 W COUNTY ROAD 2170
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78363-2720
Mailing Address - Country:US
Mailing Address - Phone:361-522-7721
Mailing Address - Fax:
Practice Address - Street 1:800 N SHORELINE BLVD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78401-3700
Practice Address - Country:US
Practice Address - Phone:361-937-7887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX157718164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse