| Doctor Name: | AMY LANGE |
| NPI Number: | 1194193912 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CPNP |
| License Number: | 209013066 |
| Business Practice Address: | 6620 Barrington Rd Hanover Park, IL - 601333935 |
| Business Phone Number: | 6308305926 |
| Business Fax Number: | |
| Mailing Address: | 6620 Barrington Rd, HANOVER PARK |
| State: | IL |
| Postal Code: | 601333935 |
| Phone Number: | 4123101286 |
| Fax Number: | |
| NPI Enumeration Date: | 09/10/2015 |
| NPI Last Update Date: | 06/09/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 209013066 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |