Doctor Name: | MRS. TRACY M LANGE |
NPI Number: | 1053636613 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 0024168745 |
Business Practice Address: | 324 T B Stanley Hwy Bassett, VA - 240556108 |
Business Phone Number: | 2766291076 |
Business Fax Number: | 2766292695 |
Mailing Address: | 324 T B Stanley Hwy, BASSETT |
State: | VA |
Postal Code: | 240556108 |
Phone Number: | 2766291076 |
Fax Number: | 2766292695 |
NPI Enumeration Date: | 04/07/2010 |
NPI Last Update Date: | 01/13/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 0024168745 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |