Provider Demographics
NPI:1093490104
Name:LANGE, JAMIE LYN (MSN, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYN
Last Name:LANGE
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 S 1040 W
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-4614
Mailing Address - Country:US
Mailing Address - Phone:801-609-2448
Mailing Address - Fax:801-609-2447
Practice Address - Street 1:822 S 1040 W
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-4614
Practice Address - Country:US
Practice Address - Phone:801-609-2448
Practice Address - Fax:801-609-2447
Is Sole Proprietor?:No
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13337252-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health