Provider Demographics
NPI:1528038106
Name:LANGE, AMY S (CNM)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:S
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 1:4043 COLFAX AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55409-1425
Mailing Address - Country:US
Mailing Address - Phone:612-822-8136
Mailing Address - Fax:
Practice Address - Street 1:1200 LAGOON AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2077
Practice Address - Country:US
Practice Address - Phone:612-823-6300
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1113365367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
07-00775OtherMEDICA
1019218OtherPREFERRED ONE
930063OtherAMERICA'S PPO (ARAZ)
HP22762OtherHEALTH PARTNERS
MN37B63LAOtherBCBS MN
109104OtherUCARE
32427OtherSIOUX VALLEY HEALTH PLAN
HP22762OtherHEALTH PARTNERS