Provider Demographics
NPI:1740394055
Name:LANGE, MARY PATRICIA (PHD, NP)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:PATRICIA
Last Name:LANGE
Suffix:
Gender:F
Credentials:PHD, NP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:PATRICIA
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29344 GLENCASTLE DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-1418
Mailing Address - Country:US
Mailing Address - Phone:248-478-6199
Mailing Address - Fax:
Practice Address - Street 1:4601 JOHN R
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-576-3955
Practice Address - Fax:313-576-1191
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704103457363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care