Provider Demographics
NPI:1265278337
Name:PLANGE, JACOB
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:PLANGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 ADELAIDE ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NH
Mailing Address - Zip Code:03051-4357
Mailing Address - Country:US
Mailing Address - Phone:781-775-0302
Mailing Address - Fax:
Practice Address - Street 1:60 ADELAIDE ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NH
Practice Address - Zip Code:03051-4357
Practice Address - Country:US
Practice Address - Phone:781-775-0302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2301226163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health