Provider Demographics
NPI:1982856134
Name:LANGE, CHRISTINE ANNETTE (RN, RCS)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ANNETTE
Last Name:LANGE
Suffix:
Gender:F
Credentials:RN, RCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 ALTA LOMA DR
Mailing Address - Street 2:
Mailing Address - City:THIENSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53092-1456
Mailing Address - Country:US
Mailing Address - Phone:262-242-2887
Mailing Address - Fax:
Practice Address - Street 1:428 ALTA LOMA DR
Practice Address - Street 2:
Practice Address - City:THIENSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53092-1456
Practice Address - Country:US
Practice Address - Phone:262-242-2887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI92136030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35070300Medicaid