Provider Demographics
NPI:1720009210
Name:LANGE, DEBRA GAIL (APRN-BC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:GAIL
Last Name:LANGE
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6273 SEQUOIA DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-9597
Mailing Address - Country:US
Mailing Address - Phone:734-483-6743
Mailing Address - Fax:734-340-3972
Practice Address - Street 1:3496 E LAKE LANSING RD
Practice Address - Street 2:SUITE 100
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-2288
Practice Address - Country:US
Practice Address - Phone:517-333-0968
Practice Address - Fax:517-333-4306
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704159635363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health