Provider Demographics
NPI:1467487702
Name:LANGE, SANDRA J (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:J
Last Name:LANGE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5732
Mailing Address - Country:US
Mailing Address - Phone:972-233-1999
Mailing Address - Fax:972-233-3666
Practice Address - Street 1:3705 MEDICAL PKWY STE 570
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1024
Practice Address - Country:US
Practice Address - Phone:512-454-2554
Practice Address - Fax:512-454-2824
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX722382367500000X
TXAP114496367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179509802Medicaid
TX86281UOtherBCBS
TX86296UOtherBCBS
TX8J0357Medicare PIN
TX8G4562Medicare PIN