Provider Demographics
NPI:1467768903
Name:LANGE, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:LANGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:GROEZINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:536 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02351-2465
Mailing Address - Country:US
Mailing Address - Phone:781-871-3773
Mailing Address - Fax:781-871-3771
Practice Address - Street 1:536 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:MA
Practice Address - Zip Code:02351-2465
Practice Address - Country:US
Practice Address - Phone:781-871-3773
Practice Address - Fax:781-871-3771
Is Sole Proprietor?:No
Enumeration Date:2010-08-22
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA285039363L00000X
MARN285039363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care