Provider Demographics
NPI:1164863635
Name:LANGE, IRENE MARGARET (RN)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:MARGARET
Last Name:LANGE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:PESHTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54157-1315
Mailing Address - Country:US
Mailing Address - Phone:715-582-0204
Mailing Address - Fax:
Practice Address - Street 1:300 MAPLE ST
Practice Address - Street 2:
Practice Address - City:PESHTIGO
Practice Address - State:WI
Practice Address - Zip Code:54157-1315
Practice Address - Country:US
Practice Address - Phone:715-582-0204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI186062-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse