Provider Demographics
NPI:1295071066
Name:LANG, LYNNE CHARLENE (RN)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:CHARLENE
Last Name:LANG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17130 51ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6705
Mailing Address - Country:US
Mailing Address - Phone:425-876-2854
Mailing Address - Fax:
Practice Address - Street 1:1601 AVENUE D
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-1718
Practice Address - Country:US
Practice Address - Phone:360-563-7264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-21
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00120618163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health