Provider Demographics
NPI:1114543220
Name:LANGE, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:LANGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14455 STREICH RD
Mailing Address - Street 2:
Mailing Address - City:ELMENDORF
Mailing Address - State:TX
Mailing Address - Zip Code:78112-9773
Mailing Address - Country:US
Mailing Address - Phone:210-852-5589
Mailing Address - Fax:
Practice Address - Street 1:14455 STREICH RD
Practice Address - Street 2:
Practice Address - City:ELMENDORF
Practice Address - State:TX
Practice Address - Zip Code:78112-9773
Practice Address - Country:US
Practice Address - Phone:210-852-5589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX150070164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse