Provider Demographics
NPI:1164907879
Name:LANGE, SCARLETT
Entity Type:Individual
Prefix:
First Name:SCARLETT
Middle Name:
Last Name:LANGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SCARLETT
Other - Middle Name:RASBERRY
Other - Last Name:BOLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:646 LOOP RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-2450
Mailing Address - Country:US
Mailing Address - Phone:318-366-0633
Mailing Address - Fax:
Practice Address - Street 1:3801 CHAUVIN LN
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-1911
Practice Address - Country:US
Practice Address - Phone:318-366-0633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN127938163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty