Provider Demographics
NPI:1194193912
Name:LANGE, AMY (CPNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:LANGE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 820
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2615
Mailing Address - Country:US
Mailing Address - Phone:312-202-0300
Mailing Address - Fax:312-202-0383
Practice Address - Street 1:737 N MICHIGAN AVE
Practice Address - Street 2:SUITE 820
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2615
Practice Address - Country:US
Practice Address - Phone:312-202-0300
Practice Address - Fax:312-202-0383
Is Sole Proprietor?:No
Enumeration Date:2015-09-10
Last Update Date:2016-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209013066363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics