Provider Demographics
NPI:1639776883
Name:LANGE-SMITH, GAIL
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:LANGE-SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 BEECHWOOD ST APT 3
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-1974
Mailing Address - Country:US
Mailing Address - Phone:870-210-9054
Mailing Address - Fax:
Practice Address - Street 1:805 BEECHWOOD ST APT 3
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-1974
Practice Address - Country:US
Practice Address - Phone:870-210-9054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered