Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | SP010453 | PA |
N | 363LP2300X | Nurse Practitioner - Primary Care | COA14433NP | OH |
NPI | 1043546443 |
---|---|
Provider Name | Sandra Lang |
First Address | Weirton, WV 26062-4637 |
Second Address | Wintersville, OH 43953-3973 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2009 |
Last Update Date | 17/06/2013 |