Provider Demographics
NPI:1649233081
Name:MCGUIRE LANG, DEBRA MARY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:MARY
Last Name:MCGUIRE LANG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:710 COMMERCE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4925
Mailing Address - Country:US
Mailing Address - Phone:651-968-5201
Mailing Address - Fax:651-968-5904
Practice Address - Street 1:1645 LYNDALE AVE N STE 103
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-2935
Practice Address - Country:US
Practice Address - Phone:651-968-5201
Practice Address - Fax:651-968-5904
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9516363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0112308OtherMEDICA, FARIBAULT
MN151647C572OtherUCARE MN
MN74B41MCOtherBCBS OF MN
MN970001089Medicare ID - Type UnspecifiedMEDICARE
MN0112309OtherMEDICA, NORTHFIELD
MN983180127858OtherPREFERRED ONE
MNP35097Medicare UPIN
MN970020574Medicare ID - Type UnspecifiedPALMETTO GBA, RR MC
MN0112310OtherMEDICA, MANKATO
MN230714600Medicaid
MNHP32904OtherHEALTH PARTNERS