Provider Demographics
NPI:1275173858
Name:LANGE, KARIS A (PA-C)
Entity Type:Individual
Prefix:
First Name:KARIS
Middle Name:A
Last Name:LANGE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3901 PINE LAKE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5497
Mailing Address - Country:US
Mailing Address - Phone:402-420-1212
Mailing Address - Fax:402-328-0961
Practice Address - Street 1:3901 PINE LAKE RD STE 120
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5497
Practice Address - Country:US
Practice Address - Phone:402-420-1212
Practice Address - Fax:402-328-0961
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE2423363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant