Provider Demographics
NPI:1437195351
Name:LANGE, GAZELLE G (CNM)
Entity Type:Individual
Prefix:MS
First Name:GAZELLE
Middle Name:G
Last Name:LANGE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 S FRENCH BROAD AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4364
Mailing Address - Country:US
Mailing Address - Phone:484-994-9196
Mailing Address - Fax:
Practice Address - Street 1:390 S FRENCH BROAD AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4364
Practice Address - Country:US
Practice Address - Phone:484-994-9196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW010039367A00000X
NC868367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3502425OtherAETNA FACILITY HMO
PA1644747OtherPERSONAL CHOICE PROF
PA7016198OtherAETNA PPO
PA2319725000OtherKEYSTONE PROFESSIONAL