Provider Demographics
NPI:1083694913
Name:LANGE, ELAINE GAIL (RN, APN)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:GAIL
Last Name:LANGE
Suffix:
Gender:F
Credentials:RN, APN
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:GAIL
Other - Last Name:ERNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, APN
Mailing Address - Street 1:402 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:485 WILLIAMSTOWN RD
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-1777
Practice Address - Country:US
Practice Address - Phone:856-227-6575
Practice Address - Fax:856-237-8042
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNN08298500363LA2200X
NJNO08298500163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0075337Medicaid
NJ0075337Medicaid
092654CKPMedicare PIN
077356Medicare Oscar/Certification
NJQ47550Medicare UPIN