Provider Demographics
NPI:1720597123
Name:LANGE, CHRISTOPHER MICHEAL (FNP)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:MICHEAL
Last Name:LANGE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 WINTERBERRY LN
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-4479
Mailing Address - Country:US
Mailing Address - Phone:901-258-9492
Mailing Address - Fax:
Practice Address - Street 1:101 WILBURN WAY
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-3693
Practice Address - Country:US
Practice Address - Phone:662-323-9908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902341363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily