Provider Demographics
NPI:1376647990
Name:LANG, LISA M (APRN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:LANG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:789 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2526
Mailing Address - Country:US
Mailing Address - Phone:603-516-4265
Mailing Address - Fax:603-740-2173
Practice Address - Street 1:19 OLD ROLLINSFORD RD
Practice Address - Street 2:BUILDING B
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2807
Practice Address - Country:US
Practice Address - Phone:603-516-4265
Practice Address - Fax:603-740-2173
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH034944-23363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3087699Medicaid
ME1376647990Medicaid
ME1376647990Medicaid
NH3087699Medicaid