Provider Demographics
NPI:1053301937
Name:LANGE, NANCY PATRICIA (RNCS)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:PATRICIA
Last Name:LANGE
Suffix:
Gender:F
Credentials:RNCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ROUTE 111
Mailing Address - Street 2:STE 4
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-4142
Mailing Address - Country:US
Mailing Address - Phone:603-329-5420
Mailing Address - Fax:603-329-1194
Practice Address - Street 1:16 ROUTE 111
Practice Address - Street 2:STE 4
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-4142
Practice Address - Country:US
Practice Address - Phone:603-458-5076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA161387363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANS0128Medicare ID - Type Unspecified
MASO9489Medicare UPIN