Provider Demographics
NPI:1356469985
Name:LANG, JEANNI CLANCEY
Entity type:Individual
Prefix:MRS
First Name:JEANNI
Middle Name:CLANCEY
Last Name:LANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 478
Mailing Address - Street 2:
Mailing Address - City:FIARFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94978-0478
Mailing Address - Country:US
Mailing Address - Phone:415-454-6058
Mailing Address - Fax:415-454-6078
Practice Address - Street 1:612 D ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901
Practice Address - Country:US
Practice Address - Phone:415-454-6058
Practice Address - Fax:415-454-6078
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACFM00640OtherABC
CACFM00640OtherABC