Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 074592 | MO |
NPI | 1003075391 |
---|---|
Provider Name | Margie Lange |
First Address | Belle, MO 65013-3108 |
Second Address | Belle, MO 65013-3108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2008 |
Last Update Date | 03/06/2008 |