Provider Demographics
NPI:1366045197
Name:LANGE, THERESE (MSN, NP, AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:
Last Name:LANGE
Suffix:
Gender:F
Credentials:MSN, NP, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 S NEVADA HIGHWAY 160 STE 7
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-4876
Mailing Address - Country:US
Mailing Address - Phone:702-530-2225
Mailing Address - Fax:
Practice Address - Street 1:3250 S NEVADA HIGHWAY 160 STE 7
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-4876
Practice Address - Country:US
Practice Address - Phone:702-530-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309666363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health