Provider Demographics
NPI:1780016410
Name:LANGE, SHERRIE L (PT)
Entity Type:Individual
Prefix:MS
First Name:SHERRIE
Middle Name:L
Last Name:LANGE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 6TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-2717
Mailing Address - Country:US
Mailing Address - Phone:651-403-5427
Mailing Address - Fax:651-636-0936
Practice Address - Street 1:805 6TH AVE NW
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-2717
Practice Address - Country:US
Practice Address - Phone:651-403-5427
Practice Address - Fax:651-636-0936
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1117314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility