Provider Demographics
NPI:1336176643
Name:LANG, WENDY (FNP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:LANG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 ECHO HOLLOW RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-5801
Mailing Address - Country:US
Mailing Address - Phone:541-554-8021
Mailing Address - Fax:541-607-1429
Practice Address - Street 1:1525 ECHO HOLLOW ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-1205
Practice Address - Country:US
Practice Address - Phone:541-554-8021
Practice Address - Fax:541-607-1429
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR078041312N1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR292133Medicaid
P10315Medicare UPIN
OR292133Medicaid